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NPI Code Detail

MEDICARE: PREMIER EMERGENCY PHYSICIANS OF CALIFORNIA MEDICAL GROUP PC

MEDICARE: PREMIER EMERGENCY PHYSICIANS OF CALIFORNIA MEDICAL GROUP PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1427237163
Entity Type Code : Organization
Provider Name (Legal Business Name) : PREMIER EMERGENCY PHYSICIANS OF CALIFORNIA MEDICAL GROUP PC
Provider Business Mailing Address
First Line : 5565 CENTERVIEW DR STE 107
Second Line :
City : RALEIGH
State : NC
Zip : 27606-3563
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1191 PHELPS AVE
Second Line :
City : COALINGA
State : CA
Zip : 93210-9609
Country : US
Telephone Number : 559-935-6400
Fax Number :
Authorized Official
Title or Position : OFFICER
Name : KATHY KONDAS
Credential :
Telephone Number : 973-251-1132
Provider Enumeration Date : 10/30/2007
Last Update Date : 04/09/2021

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Directions to “PREMIER EMERGENCY PHYSICIANS OF CALIFORNIA MEDICAL GROUP PC ” Practice Location

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