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NPI Code Detail

MEDICARE: MANTECA MEDICAL GROUP, INC

MEDICARE: MANTECA MEDICAL GROUP, INC
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
1207V00000XObstetrics & Gynecology Physician20A7379CA
2207R00000XInternal Medicine PhysicianA54203CA
3207V00000XObstetrics & Gynecology PhysicianG55402CA
4208000000XPediatrics PhysicianA51139CA
5208000000XPediatrics PhysicianA50060CA
6207Q00000XFamily Medicine PhysicianA24460CA
7207R00000XInternal Medicine PhysicianC43012CA

General Provider Information

NPI Number : 1437113065
Entity Type Code : Organization
Provider Name (Legal Business Name) : MANTECA MEDICAL GROUP, INC
Provider Business Mailing Address
First Line : 1262 E NORTH ST
Second Line :
City : MANTECA
State : CA
Zip : 95336-4962
Country : US
Telephone Number : 209-823-7646
Fax Number : 209-824-5374
Provider Business Practice Location Address
First Line : 1262 E NORTH ST
Second Line :
City : MANTECA
State : CA
Zip : 95336-4962
Country : US
Telephone Number : 209-823-7646
Fax Number : 209-824-5374
Authorized Official
Title or Position : CFO/COO
Name : DR. TERRY CROASDALE
Credential : M.D.
Telephone Number : 209-823-7646
Provider Enumeration Date : 04/12/2006
Last Update Date : 04/09/2010

Similar Medicare Providers

1447258272 — DR. BLISS WATSON CLARK II M.D.
Practice Location Address:
1262 E NORTH ST
MANTECA, CA
95336-4962
Practice Phone: 209-214-7053
Practice Fax: 209-523-0764
1861470791 — DR. KARL KONRAD WOLF M.D.
Practice Location Address:
1262 E NORTH ST
MANTECA, CA
95336-4962
Practice Phone: 209-823-7646
Practice Fax: 209-824-5374
1295713147 — DR. TERRY LEE CROASDALE M.D.
Practice Location Address:
1262 E NORTH ST
MANTECA, CA
95336-4962
Practice Phone: 209-823-7646
Practice Fax: 209-239-9594
1386821452 — LINDA L PICKHARTZ NP
Practice Location Address:
1262 E NORTH ST
MANTECA, CA
95336-4962
Practice Phone: 209-823-7646
Practice Fax: 209-824-5374
1447560255 — HOWARD C. MILLER, D.P.M., INC.
Practice Location Address:
1210 E NORTH ST
MANTECA, CA
95336-4962
Practice Phone: 209-823-9378
Practice Fax:
1386943546 — MRS. JANNA BERNICE BROCCHINI FNP
Practice Location Address:
1262 E NORTH ST
MANTECA, CA
95336-4962
Practice Phone: 209-599-3860
Practice Fax: 209-599-9662

Directions to “MANTECA MEDICAL GROUP, INC ” Practice Location

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