Basic Information
| Provider Information | |||||||||
| NPI: | 1780644567 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OAKHURST MEDICAL GROUP INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 40232 JUNCTION DRIVE | ||||||||
| Address2: | |||||||||
| City: | OAKHURST | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596586420 | ||||||||
| FaxNumber: | 5596586460 | ||||||||
| Practice Location | |||||||||
| Address1: | 40232 JUNCTION DRIVE | ||||||||
| Address2: | |||||||||
| City: | OAKHURST | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596586420 | ||||||||
| FaxNumber: | 5596586460 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2006 | ||||||||
| LastUpdateDate: | 07/08/2010 | ||||||||
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| AuthorizedOfficialLastName: | MORRIS | ||||||||
| AuthorizedOfficialFirstName: | REBECCA | ||||||||
| AuthorizedOfficialMiddleName: | ANNE | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 5596586420 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | GF0067330 | 05 | CA | MEDICAID |