| Folsom Family And Sports Medical Group Inc. | |
|
2545 E Bidwell St Ste 110 Folsom CA 95630-6443 | |
| (916) 941-7362 | |
| (866) 779-3899 |
| Full Name | Folsom Family And Sports Medical Group Inc. |
|---|---|
| Speciality | Family Medicine |
| Location | 2545 E Bidwell St Ste 110, Folsom, California |
| Authorized Official Name and Position | Melanie Miller (MANAGER) |
| Authorized Official Contact | 9163653431 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Folsom Family And Sports Medical Group Inc. 2545 E Bidwell St Ste 110 Folsom CA 95630-6443 Ph: (916) 941-7362 | Folsom Family And Sports Medical Group Inc. 2545 E Bidwell St Ste 110 Folsom CA 95630-6443 Ph: (916) 941-7362 |
| NPI Number | 1629372073 |
|---|---|
| Provider Enumeration Date | 12/28/2010 |
| Last Update Date | 12/31/2024 |
| Medicare PECOS PAC ID | 3870782766 |
|---|---|
| Medicare Enrollment ID | O20110107000278 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629372073 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | A64163 (California) | Primary |
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
| Provider Name | Cheryl A Matossian |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1740379072 PECOS PAC ID: 1951364199 Enrollment ID: I20041108001290 |
| Provider Name | Kelley Manion Leonard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275822520 PECOS PAC ID: 2163661711 Enrollment ID: I20150716001541 |
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