Executive Medical & Surgical Associates Inc.
Organization Active NPI Orthopaedic Surgery of the Spine Physician · Colton, CA
NPI 1336299072 · NPPES record last updated Jul 16, 2015
Key facts
- NPI
- 1336299072
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Orthopaedic Surgery of the Spine Physician 207XS0117X
- Legal business name
- EXECUTIVE MEDICAL & SURGICAL ASSOCIATES INC.
- Practice address
- 900 E Washington St
Suite 300
Colton, CA 92324 - Phone
- (909) 824-2422
- Fax
- (909) 824-8234
- NPI assigned
- Jan 12, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. Darren L Bergey, MD
- Title
- Ceo
- Phone
- (909) 824-2422
Practitioners 1
-
Darren L Bergey, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070131000368 | CA | Part B Supplier - Clinic/Group Practice | 2062413255 |
Receives reassigned benefits from 1 practitioner Practice locations: Orange, CA; Riverside, CA |
National Provider Directory
Locations
2190 Market St
Ste A
Riverside, CA 92501
Phone (909) 824-2422
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopaedic Surgery of the Spine Physician |
207XS0117X | Yes |
Addresses
Primary practice location
900 E Washington St
Suite 300
Colton, CA 92324
Mailing address
PO Box 894773
Los Angeles, CA 90189-4773
Phone (909) 824-2422
Other providers in Colton, CA
- Matthew Ewell
- Kathleen Ewing
- Excelcare Hospice Inc
- Executive Medical & Surgical Assoc. Inc.
- Executive Medical & Surgical Associates Inc.
- Julie O Eze
- Czarina Irish Facer
- Faculty Medical Group of Llusm
- Faculty Physicians and Surgeons of Llusm
- Ambarin Salma Faizi
All providers in Colton, CA · Orthopaedic Surgery of the Spine Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 16, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.