Independence Medical Group of Central California, Inc.

Primary specialty

Health Maintenance OrganizationTaxonomy code 302R00000X

Legal business name

INDEPENDENCE MEDICAL GROUP OF CENTRAL CALIFORNIA, INC.

Doing business as

Independence Medical Group

Practice address

100 Willow PLZ
Suite 405
Visalia, CA 93291-6206

Phone

(559) 802-1105

Fax

(559) 750-4081

NPI assigned

Apr 7, 2009

Last updated

Apr 7, 2009By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Charles Haberkern

Title

Vice President

Phone

(661) 496-5638

Specialties & licenses 1

Addresses

Other names 1

• Independence Medical Group Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1239062400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1239062400000",
    "number": "1477796464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 WILLOW PLZ",
            "address_2": "SUITE 405",
            "city": "VISALIA",
            "state": "CA",
            "postal_code": "932916206",
            "telephone_number": "559-802-1105",
            "fax_number": "559-750-4081"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 WILLOW PLZ",
            "address_2": "SUITE 405",
            "city": "VISALIA",
            "state": "CA",
            "postal_code": "932916206",
            "telephone_number": "559-802-1105",
            "fax_number": "559-750-4081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDEPENDENCE MEDICAL GROUP OF CENTRAL CALIFORNIA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-07",
        "last_updated": "2009-04-07",
        "status": "A",
        "authorized_official_last_name": "HABERKERN",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "661-496-5638"
    },
    "taxonomies": [
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Independence Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Health Maintenance Organization in Visalia, CA
• Providers in Visalia, CA by specialty
• Health Maintenance Organization in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.