Basic Information
| Provider Information | |||||||||
| NPI: | 1407839541 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ANTHONY & ZINKE FAMILY MEDICAL GROUP INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 265 POSADA LN | ||||||||
| Address2: | SUITE B | ||||||||
| City: | TEMPLETON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934654056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8054340900 | ||||||||
| FaxNumber: | 8054349260 | ||||||||
| Practice Location | |||||||||
| Address1: | 265 POSADA LN | ||||||||
| Address2: | SUITE B | ||||||||
| City: | TEMPLETON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934654056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8054340900 | ||||||||
| FaxNumber: | 8054349260 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2005 | ||||||||
| LastUpdateDate: | 09/16/2011 | ||||||||
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| AuthorizedOfficialLastName: | ANTHONY | ||||||||
| AuthorizedOfficialFirstName: | ANDREW | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 8054340900 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | A0582376 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | ZZZ05030Z | 01 | CA | BLUE SHIELD OF CA | OTHER | 600900900 | 01 | USDL | OTHER |