Provider Demographics
NPI:1194276261
Name:VALLEY CHILDREN'S MEDICAL GROUP
Entity type:Organization
Organization Name:VALLEY CHILDREN'S MEDICAL GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICE
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDRING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-353-5010
Mailing Address - Street 1:9300 VALLEY CHILDRENS PL
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93636-8761
Mailing Address - Country:US
Mailing Address - Phone:559-353-3000
Mailing Address - Fax:
Practice Address - Street 1:9900 STOCKDALE HWY
Practice Address - Street 2:SUITE 105
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-3632
Practice Address - Country:US
Practice Address - Phone:661-410-9500
Practice Address - Fax:661-410-9501
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VALLEY CHILDREN'S MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-24
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty