Provider Demographics
NPI:1588072698
Name:NEWSTART MEDICAL GROUP INC
Entity type:Organization
Organization Name:NEWSTART MEDICAL GROUP INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:STEFFENS
Authorized Official - Suffix:SR
Authorized Official - Credentials:DO
Authorized Official - Phone:615-604-0142
Mailing Address - Street 1:PO BOX 486
Mailing Address - Street 2:
Mailing Address - City:WEIMAR
Mailing Address - State:CA
Mailing Address - Zip Code:95736-0486
Mailing Address - Country:US
Mailing Address - Phone:530-296-4417
Mailing Address - Fax:877-425-5508
Practice Address - Street 1:20601 WEST PAOLI LANE
Practice Address - Street 2:
Practice Address - City:WEIMAR
Practice Address - State:CA
Practice Address - Zip Code:95736-0486
Practice Address - Country:US
Practice Address - Phone:530-296-4417
Practice Address - Fax:877-425-5508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-01
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care