Basic Information
| Provider Information | |||||||||
| NPI: | 1477653574 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AMADOR EMERGENCY PHYSICIANS MEDICAL GROUP, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 11949 | ||||||||
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| City: | WESTMINSTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926851949 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8668832374 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1100 BUTTE STREET | ||||||||
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| City: | REDDING | ||||||||
| State: | CA | ||||||||
| PostalCode: | 960010852 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5302445400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2006 | ||||||||
| LastUpdateDate: | 10/22/2010 | ||||||||
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| AuthorizedOfficialLastName: | MARON | ||||||||
| AuthorizedOfficialFirstName: | STEVE | ||||||||
| AuthorizedOfficialMiddleName: | P. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5302445400 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | GR0101111 | 05 | CA | MEDICAID |