Provider Demographics
NPI:1861727372
Name:POWAY MEDICAL CLINIC, INCORPORATED
Entity type:Organization
Organization Name:POWAY MEDICAL CLINIC, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:THYGESON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-486-9100
Mailing Address - Street 1:13525 MIDLAND RD
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-4771
Mailing Address - Country:US
Mailing Address - Phone:858-486-9100
Mailing Address - Fax:858-486-9101
Practice Address - Street 1:13525 MIDLAND RD
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-4771
Practice Address - Country:US
Practice Address - Phone:858-486-9100
Practice Address - Fax:858-486-9101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-16
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care