Provider Demographics
NPI:1912907114
Name:PREMIER FAMILY MEDICINE ASSOCIATES, INC
Entity type:Organization
Organization Name:PREMIER FAMILY MEDICINE ASSOCIATES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SNEZANA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEGOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-469-9494
Mailing Address - Street 1:1770 N ORANGE GROVE AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-3027
Mailing Address - Country:US
Mailing Address - Phone:909-469-9494
Mailing Address - Fax:909-469-2120
Practice Address - Street 1:1770 N ORANGE GROVE AVE STE 101
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-3027
Practice Address - Country:US
Practice Address - Phone:909-469-9494
Practice Address - Fax:909-469-2120
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREMIER FAMILY MEDICINE ASSOCIATES,INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-28
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1912907114Medicaid
CAGR0083730Medicaid
CA00127095OtherPOMONA BUSINESS LICENSE
CG8716OtherRAILROAD MEDICARE
ZZZ57392ZOtherBLUE SHIELD OF CALIFORNIA
CA05D0931230OtherCLIA