Provider Demographics
NPI:1962519868
Name:PROFESSIONAL MEDICAL CLINIC FOR WOMEN-SACRAMENTO, INC.
Entity type:Organization
Organization Name:PROFESSIONAL MEDICAL CLINIC FOR WOMEN-SACRAMENTO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:H
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-392-2290
Mailing Address - Street 1:7237 E SOUTHGATE DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-2637
Mailing Address - Country:US
Mailing Address - Phone:916-392-2290
Mailing Address - Fax:916-392-3706
Practice Address - Street 1:7237 E SOUTHGATE DR
Practice Address - Street 2:SUITE C
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2637
Practice Address - Country:US
Practice Address - Phone:916-392-2290
Practice Address - Fax:916-392-3706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG37098207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0005730Medicaid
ZZZ87162ZMedicare PIN