| Civic Medical Center, Inc. | |
|
2147 Mowry Ave Suite D4 Fremont CA 94538-1724 | |
| (510) 574-0800 | |
| (510) 574-0850 |
| Full Name | Civic Medical Center, Inc. |
|---|---|
| Speciality | Internal Medicine |
| Location | 2147 Mowry Ave, Fremont, California |
| Authorized Official Name and Position | Namrata Mehta (OFFICE MANAGER) |
| Authorized Official Contact | 5105740800 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Civic Medical Center, Inc. 2147 Mowry Ave Suite D4 Fremont CA 94538-1724 Ph: (510) 574-0800 | Civic Medical Center, Inc. 2147 Mowry Ave Suite D4 Fremont CA 94538-1724 Ph: (510) 574-0800 |
| NPI Number | 1629482757 |
|---|---|
| Provider Enumeration Date | 06/17/2014 |
| Last Update Date | 09/29/2014 |
| Medicare PECOS PAC ID | 6002037447 |
|---|---|
| Medicare Enrollment ID | O20141028000869 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629482757 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Bala Padmanaban Annadurai |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1033100516 PECOS PAC ID: 2264414200 Enrollment ID: I20040603000976 |
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