MEDICARE: CALIFORNIA COLON AND RECTAL CANCER SCREENING CENTER LLC

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
1	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1558672626
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CALIFORNIA COLON AND RECTAL CANCER SCREENING CENTER LLC

Provider Business Mailing Address
First Line	:	451 E ALMOND AVE
Second Line	:	SUITE 103
City	:	MADERA
State	:	CA
Zip	:	93637-5562
Country	:	US
Telephone Number	:	559-438-0017
Fax Number	:	559-438-8882

Provider Business Practice Location Address
First Line	:	7121 N WHITNEY AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93720-0000
Country	:	US
Telephone Number	:	559-438-0017
Fax Number	:	559-438-8882

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. NAEEM M AKHTAR
Credential	:	MD
Telephone Number	:	559-438-0017

Provider Enumeration Date	:	06/23/2010
Last Update Date	:	11/04/2010

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