| Family & Industrial Medical Center, Inc. | |
|
47 Santa Rosa St San Luis Obispo CA 93405-5816 | |
| (805) 542-9596 | |
| (805) 542-0845 |
| Full Name | Family & Industrial Medical Center, Inc. |
|---|---|
| Speciality | Family Medicine |
| Location | 47 Santa Rosa St, San Luis Obispo, California |
| Authorized Official Name and Position | Barbara M Landis (OFFICE MANAGER) |
| Authorized Official Contact | 8055471255 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Family & Industrial Medical Center, Inc. 47 Santa Rosa St San Luis Obispo CA 93405-5816 Ph: (805) 542-9596 | Family & Industrial Medical Center, Inc. 47 Santa Rosa St San Luis Obispo CA 93405-5816 Ph: (805) 542-9596 |
| NPI Number | 1235262734 |
|---|---|
| Provider Enumeration Date | 03/13/2007 |
| Last Update Date | 06/16/2014 |
| Medicare PECOS PAC ID | 1759318256 |
|---|---|
| Medicare Enrollment ID | O20050726000536 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235262734 | NPI | - | NPPES |
| ZZZ27461Z | Other | CA | BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Mark A Ward |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1639110257 PECOS PAC ID: 5799699484 Enrollment ID: I20031117000801 |
| Provider Name | Nancy J Walden |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275739245 PECOS PAC ID: 6800833617 Enrollment ID: I20050413000748 |
| Provider Name | Jack L St Clair |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1184681298 PECOS PAC ID: 5799721502 Enrollment ID: I20050701000533 |
| Provider Name | Rina A Kadakia |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1700946332 PECOS PAC ID: 0941307433 Enrollment ID: I20070517000401 |
| Provider Name | Gary M Raymond |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134171390 PECOS PAC ID: 1658350970 Enrollment ID: I20090519000408 |
| Provider Name | David Gingrich |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1134252653 PECOS PAC ID: 1052596178 Enrollment ID: I20110504000489 |
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