Basic Information
| Provider Information | |||||||||
| NPI: | 1275821308 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MEMORIAL EMERGENCY PHYSICIANS MEDICAL GROUP, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1990 N CALIFORNIA BLVD. | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | WALNUT CREEK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945967249 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9252255837 | ||||||||
| FaxNumber: | 9254822819 | ||||||||
| Practice Location | |||||||||
| Address1: | 47111 MONROE ST | ||||||||
| Address2: | |||||||||
| City: | INDIO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922016739 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003476191 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2011 | ||||||||
| LastUpdateDate: | 07/11/2011 | ||||||||
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| AuthorizedOfficialLastName: | MARON | ||||||||
| AuthorizedOfficialFirstName: | STEVE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9252255837 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207PE0004X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine | Emergency Medical Services |
No ID Information.