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PEDIATRIC MEDICAL GROUP OF SANTA MARIA INC NPI 1811091952


NPI Information

NPI: 1811091952
Provider Name: PEDIATRIC MEDICAL GROUP OF SANTA MARIA INC
Classification: Pediatrics - 208000000X
Entity Type: Organization

CLIA Number: 05D0702969

Address:
1430 E MAIN ST
#201
SANTA MARIA, CA
ZIP 93454
Phone: (805) 922-3548
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PEDIATRIC MEDICAL GROUP OF SANTA MARIA INC is a pediatrics in Santa Maria, CA. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. PEDIATRIC MEDICAL GROUP OF SANTA MARIA INC NPI is 1811091952. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1430 E MAIN ST
#201
SANTA MARIA, CA
ZIP 93454
Phone: (805) 922-3548
Fax: (805) 928-5609

The provider's authorized official is Shane D Rostermundt .
The authorized official title is Physician Manager and has the following contact phone number (805) 922-3548.

The CLIA number assigned to this NPI record is 05D0702969 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 9/11/2006 and was last updated on 3/3/2011.


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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1208000000XPediatricsYes

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 IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1YYY48371YMEDICAIDCALIFORNIA

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: 11/14/2023

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