Yucaipa Family Medical Group, Inc.

Primary specialty

Non-Pharmacy Dispensing SiteTaxonomy code 332900000X

License

20A6282 Issued in CA

Legal business name

YUCAIPA FAMILY MEDICAL GROUP, INC.

Practice address

34636 County Line Rd
#32
Yucaipa, CA 92399-5393

Phone

(909) 795-4440

NPI assigned

Feb 14, 2007

Organization subpart

Yes

Parent organization

MEDVANTX, INCAs reported in NPPES

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

Authorized official

Name

Kenny Heine

Title

Director of Operations

Phone

(858) 625-2990

Specialties & licenses 1

Addresses

Tax ID family

Tonda D Bradshaw D O a Professional Corporation2 organizations share this tax ID, including this one

Part of

Tri - State Medical Group Inc

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Tonda D Bradshaw D O a Professional Corporation

  • Primary Care Clinic/Center
  • Yucaipa, CA
  • NPI 1871777664
  NPD tax ID

Practitioners 1

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

• Tonda Dale Bradshaw, DO

  • Internal Medicine Physician
  • Yucaipa, CA
  • NPI 1760574123
  NPD (past)

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

{
    "created_epoch": "1171411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350432000000",
    "number": "1972646784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5626 OBERLIN DR",
            "address_2": "SUITE 110",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921211705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34636 COUNTY LINE RD",
            "address_2": "#32",
            "city": "YUCAIPA",
            "state": "CA",
            "postal_code": "923995393",
            "telephone_number": "909-795-4440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YUCAIPA FAMILY MEDICAL GROUP, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDVANTX, INC",
        "enumeration_date": "2007-02-14",
        "last_updated": "2012-10-17",
        "status": "A",
        "authorized_official_last_name": "HEINE",
        "authorized_official_first_name": "KENNY",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "858-625-2990"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "CA",
            "license": "20A6282",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Xander Marriage and Family Therapy Inc
• Tonya Ann Yoney, DO
• Cheree Yorba, MS
• David You
• Yucaipa Family Dentistry
• Yucaipa Family Pharmacy
• Yucaipa Hearing Aid Center, Inc
• Yucaipa Valley Pediatric Living Inc
• Yucaipa-Calimesa Joint Usd
• Yuhca HC, LLC

• Non-Pharmacy Dispensing Site in Yucaipa, CA
• Providers in Yucaipa, CA by specialty
• Non-Pharmacy Dispensing Site in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2012; 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.