PEACHWOOD MEDICAL GROUP CLOVIS INC NPI 1831170745

NPI Information

NPI: 1831170745
Provider Name: PEACHWOOD MEDICAL GROUP CLOVIS INC
Classification: General Practice - 208D00000X
Entity Type: Organization
Address:
275 W HERNDON AVE
CLOVIS, CA
ZIP 93612
Phone: (559) 324-6200
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PEACHWOOD MEDICAL GROUP CLOVIS INC is a general practice in Clovis, CA. The provider is a physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee PEACHWOOD MEDICAL GROUP CLOVIS INC NPI is 1831170745. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

275 W HERNDON AVE
CLOVIS, CA
ZIP 93612-204
Phone: (559) 324-6200
Fax: (559) 324-6280

The provider's authorized official is Lee Roy Copeland .
The authorized official title is President and has the following contact phone number (559) 324-6200.

The enumeration date for this NPI number is 11/8/2005 and was last updated on 3/23/2010.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	Primary
1	207Q00000X	Family Medicine		No
2	207R00000X	Internal Medicine		No
3	207V00000X	Obstetrics & Gynecology		No
4	208000000X	Pediatrics		No
5	261QU0200X	Clinic/Center	Urgent Care	No
6	208D00000X	General Practice		Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	ZZZ47189Z	MEDICARE ID-TYPE UNSPECIFIED	CALIFORNIA	MEDICARE GROUP NUMBER
2	GR0066590	MEDICAID	CALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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