Providence Medical Group
Organization Active NPI General Acute Care Hospital · Bakersfield, CA
NPI 1194196832 · NPPES record last updated Oct 7, 2015
Key facts
- NPI
- 1194196832
- Entity type
- Organization (NPI type 2)
- Primary specialty
- General Acute Care Hospital 282N00000X
- License
- PA19685 (CA)
- Legal business name
- PROVIDENCE MEDICAL GROUP
- Practice address
- 1806 Wadsworth Avenue
Bakersfield, CA 93311 - Phone
- (805) 748-1687
- NPI assigned
- Oct 7, 2015
- Organization subpart
- No
Authorized official
- Name
- Mr. Matthew Tate, PA-C
- Title
- Physician Assistant
- Phone
- (805) 748-1687
Corporate family (same tax ID) 24
National Provider Directory
- Tax ID family
- Community Care Services
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Acute Care Hospital | 282N00000X | PA19685 | CA | Yes |
Addresses
Primary practice location
1806 Wadsworth Avenue
Bakersfield, CA 93311
Mailing address
1806 Wadsworth Avenue
Bakersfield, CA 93311
Phone (805) 748-1687
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All providers in Bakersfield, CA · General Acute Care Hospital in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 7, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.