TRI-VALLEY MEDICAL GROUP, INC - NPI NUMBER 1609186832

Summary

Provider Name: TRI-VALLEY MEDICAL GROUP, INC

NPI Number: 1609186832

Clasification: Internal Medicine (207RR0500X)

Specialization: Rheumatology

Address:
39765 DATE ST
SUITE 102
MURRIETA, CA
ZIP 92563

Phone Number: (951) 894-5541



Detailed Information

TRI-VALLEY MEDICAL GROUP, INC is a rheumatology internist in Murrieta, CA. The provider is an internist who treats diseases of joints, muscle, bones and tendons. This specialist diagnoses and treats arthritis, back pain, muscle strains, common athletic injuries and "collagen" diseases. The assigned NPI number for this provider is 1609186832 and is registered as an organization entity type and is a multi-specialty group.

The provider's business address is:

39765 DATE ST
SUITE 102
MURRIETA, CA
ZIP 92563-005
Phone: (951) 894-5541
Fax: (951) 894-4773

The provider's authorized official is Charles Payton .
The authorized official title is Vp/chief Medical Officer and has the following contact phone number (909) 335-4101.

The enumeration date for this NPI number is 10/21/2010 and was last updated on 10/21/2010.

Map - Location of Practice

Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 207RR0500X Internal Medicine Rheumatology No
2 207V00000X Obstetrics & Gynecology No
3 207R00000X Internal Medicine Yes

NPI Record

No. Field Name Field Value Field Definition 1
1 NPI 1609186832 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 2 Other first name by which the provider being identified is or has been known (if an individual). This may be the same as the ‘‘Provider first name’’ if the provider is or has been known by a different last name only.
3 Employer Identification Number EIN The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
4 Provider Organization Name Legal Business Name TRI-VALLEY MEDICAL GROUP, INC The name of the organization provider. If the provider is an organization, this is the legal business name.
5 Provider First Line Business Practice Location Address 39765 DATE ST The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
6 Provider Second Line Business Practice Location Address SUITE 102 The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
7 Provider Business Practice Location Address City Name MURRIETA The city name in the location address of the provider being identified.
8 Provider Business Practice Location Address State Name CA The State code in the location of the provider being identified.
9 Provider Business Practice Location Address Postal Code 925632005 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
10 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
11 Provider Business Practice Location Address Telephone Number 9518945541 The telephone number associated with the location address of the provider being identified.
12 Provider Business Practice Location Address Fax Number 9518944773 The fax number associated with the location address of the provider being identified.
13 Provider Enumeration Date 10/21/2010 The date the provider was assigned a unique identifier (assigned an NPI).
14 Last Update Date 10/21/2010 The date that a record was last updated or changed.
15 Authorized Official Last Name PAYTON The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
16 Authorized Official First Name CHARLES The first name of the authorized official.
17 Authorized Official Title or Position VP/CHIEF MEDICAL OFFICER The title or position of the authorized official.
18 Authorized Official Telephone Number 9093354101 The 10-position telephone number of the authorized official.
19 Healthcare Provider Taxonomy Code 1 207RR0500X The 10-position telephone number of the authorized official.
20 Healthcare Provider Primary Taxonomy Switch 1 N
21 Healthcare Provider Taxonomy Code 2 207V00000X
22 Healthcare Provider Primary Taxonomy Switch 2 N
23 Healthcare Provider Taxonomy Code 3 207R00000X
24 Healthcare Provider Primary Taxonomy Switch 3 Y
25 Is Organization Subpart N
26 Authorized Official Name Prefix Text DR.
27 Authorized Official Credential Text M.D.
28 Healthcare Provider Taxonomy Group 1 193200000X MULTI-SPECIALTY GROUP
29 Healthcare Provider Taxonomy Group 2 193200000X MULTI-SPECIALTY GROUP
30 Healthcare Provider Taxonomy Group 3 193200000X MULTI-SPECIALTY GROUP

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This page was last updated on: 4/19/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

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