| Formula Medical Group A Professional Medical Corporation | |
|
18182 Us Highway 18 Suite 105 Apple Valley CA 92307-2200 | |
| (760) 242-1234 | |
| (760) 242-5527 |
| Full Name | Formula Medical Group A Professional Medical Corporation |
|---|---|
| Speciality | Family Medicine |
| Location | 18182 Us Highway 18, Apple Valley, California |
| Authorized Official Name and Position | James Krider (DOCTOR) |
| Authorized Official Contact | 7602421234 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Formula Medical Group A Professional Medical Corporation 18182 Us Highway 18 Suite 105 Apple Valley CA 92307-2200 Ph: (760) 242-1234 | Formula Medical Group A Professional Medical Corporation 18182 Us Highway 18 Suite 105 Apple Valley CA 92307-2200 Ph: (760) 242-1234 |
| NPI Number | 1710905690 |
|---|---|
| Provider Enumeration Date | 07/18/2006 |
| Last Update Date | 05/14/2020 |
| Medicare PECOS PAC ID | 5193751808 |
|---|---|
| Medicare Enrollment ID | O20050714000153 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710905690 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | G48897 (California) | Primary |
| Provider Name | James C Krider |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1215959945 PECOS PAC ID: 7719172261 Enrollment ID: I20101110001141 |
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