| San Joaquin Prime Care Medical Group Inc | |
|
30924 E Kings Canyon Rd Squaw Valley CA 93675-9601 | |
| (559) 332-9399 | |
| (559) 332-9499 |
| Full Name | San Joaquin Prime Care Medical Group Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 30924 E Kings Canyon Rd, Squaw Valley, California |
| Authorized Official Name and Position | Kimberly Burgins (BILLING SUPERVISOR) |
| Authorized Official Contact | 5597831181 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| San Joaquin Prime Care Medical Group Inc 330 E Pine St Exeter CA 93221-1838 Ph: (559) 592-2134 | San Joaquin Prime Care Medical Group Inc 30924 E Kings Canyon Rd Squaw Valley CA 93675-9601 Ph: (559) 332-9399 |
| NPI Number | 1982891735 |
|---|---|
| Provider Enumeration Date | 09/26/2007 |
| Last Update Date | 04/27/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982891735 | NPI | - | NPPES |
| GR0084782 | Medicaid | CA | |
| 058928 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | A43893 (California) | Primary |
Stefan Pentschev Md Medical Corporation Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 30926 E Kings Canyon Rd, Squaw Valley, CA 93675 Phone: 559-332-1112 Fax: 559-332-1112 |