Provider Demographics
NPI:1366561573
Name:I FEEL GOOD MEDICAL/GEORGE J NIXON
Entity type:Organization
Organization Name:I FEEL GOOD MEDICAL/GEORGE J NIXON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOLE PROPRIETOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:NIXON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-426-2211
Mailing Address - Street 1:1113 TEXAS ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-5745
Mailing Address - Country:US
Mailing Address - Phone:707-426-2211
Mailing Address - Fax:707-434-1566
Practice Address - Street 1:1113 TEXAS ST
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-5745
Practice Address - Country:US
Practice Address - Phone:707-426-2211
Practice Address - Fax:707-434-1566
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:I FEEL GOOD MEDICAL OUTLET/GEORGE J NIXON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-28
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102823332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4541850001Medicare NSC