Provider Demographics
NPI:1902871841
Name:STARR-WOOD CARDIAC GROUP OF VISALIA MEDICAL CORPORATION, PC
Entity Type:Organization
Organization Name:STARR-WOOD CARDIAC GROUP OF VISALIA MEDICAL CORPORATION, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CARDIAC SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:MAYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-734-3278
Mailing Address - Street 1:4125 W NOBLE AVE
Mailing Address - Street 2:PMB 323
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-1662
Mailing Address - Country:US
Mailing Address - Phone:559-734-3278
Mailing Address - Fax:503-627-5723
Practice Address - Street 1:100 WILLOW PLZ
Practice Address - Street 2:SUITE 301
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-6206
Practice Address - Country:US
Practice Address - Phone:559-734-3278
Practice Address - Fax:503-627-5723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAFNP23902261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0072080Medicaid
CAGR0072080Medicaid