Provider Demographics
NPI:1194090654
Name:EDINGTON MEDICAL GROUP
Entity type:Organization
Organization Name:EDINGTON MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:BALDINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-576-2957
Mailing Address - Street 1:425 UNIVERSITY AVE
Mailing Address - Street 2:SUITE 140
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-6520
Mailing Address - Country:US
Mailing Address - Phone:916-920-1222
Mailing Address - Fax:916-920-3222
Practice Address - Street 1:425 UNIVERSITY AVE
Practice Address - Street 2:SUITE 140
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-6520
Practice Address - Country:US
Practice Address - Phone:916-920-1222
Practice Address - Fax:916-920-3222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-16
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty