Provider Demographics
NPI:1699158501
Name:MONTEREY PENINSULA ORTHOPAEDIC & SPORTS MEDICINE INSTITUTE/URGENCY MED
Entity type:Organization
Organization Name:MONTEREY PENINSULA ORTHOPAEDIC & SPORTS MEDICINE INSTITUTE/URGENCY MED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:
Authorized Official - Last Name:BELUSHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-643-9788
Mailing Address - Street 1:10 HARRIS CT STE A1
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-7823
Mailing Address - Country:US
Mailing Address - Phone:831-659-5531
Mailing Address - Fax:831-657-0161
Practice Address - Street 1:14 FORD ROAD
Practice Address - Street 2:
Practice Address - City:CARMEL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93924
Practice Address - Country:US
Practice Address - Phone:831-659-5531
Practice Address - Fax:831-657-0161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-09
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG16156174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA839718Medicare UPIN