Peachwood Medical Group Clovis Inc

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

PEACHWOOD MEDICAL GROUP CLOVIS INC

Practice address

275 W Herndon Ave
Clovis, CA 93612-0204

Phone

(559) 324-6200

Fax

(559) 324-6280

NPI assigned

Nov 8, 2005

Organization subpart

No

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

Authorized official

Name

Mr. Lee Roy Copeland, M.D.

Title

President

Phone

(559) 324-6200

Specialties & licenses 6

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Randall Scott Raun, M.D.

  • Family Medicine Physician
  • Corcoran, CA
  • NPI 1518077916
  NPD

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

{
    "created_epoch": "1131408000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1269302400000",
    "number": "1831170745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "275 W HERNDON AVE",
            "city": "CLOVIS",
            "state": "CA",
            "postal_code": "936120204",
            "telephone_number": "559-324-6200",
            "fax_number": "559-324-6280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "275 W HERNDON AVE",
            "city": "CLOVIS",
            "state": "CA",
            "postal_code": "936120204",
            "telephone_number": "559-324-6200",
            "fax_number": "559-324-6280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACHWOOD MEDICAL GROUP CLOVIS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-08",
        "last_updated": "2010-03-23",
        "status": "A",
        "authorized_official_last_name": "COPELAND",
        "authorized_official_first_name": "LEE",
        "authorized_official_middle_name": "ROY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "559-324-6200",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0066590",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carmela Jay Patio
• Marissa Paige Patterson
• Linda C. Pauls, MD
• Rebecca Kay Payne, LVN
• Peachwood Aesthetic Skincare Center Inc.
• Briana Estee Pearson
• Heather Pedersen, PH.D.
• Stacy Pederson
• Alejandra Pedraza, RN
• Pegasus Health System, Inc.

• General Practice Physician in Clovis, CA
• Providers in Clovis, CA by specialty
• General Practice Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2010; 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.