Organization Name: | EXCELLENCE MEDICAL GROUP INC |
NPI Number: | 1093074221 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | CHRISTINE ANN KING (PRESIDENT/FNP) |
Mailing Address: | 530 Kings County Dr Suite 107 Hanford |
State: | CA US |
Postal Code: | 932303579 |
Phone Number: | 5595851200 |
Fax Number: | 5595851235 |
NPI Enumeration Date: | 05/08/2012 |
NPI Last Update Date: | 05/09/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | A34991 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |