1326112533 NPI number — SIGMUND PHYSICIAN SERVICES, INC.

Table of content: (NPI 1326112533)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326112533 NPI number — SIGMUND PHYSICIAN SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SIGMUND PHYSICIAN SERVICES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MEE AT KING CITY URGENT CARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326112533
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3000 BROAD ST
Provider Second Line Business Mailing Address:
SUITE 209A
Provider Business Mailing Address City Name:
SAN LUIS OBISPO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93401-6786
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
831-386-7493
Provider Business Mailing Address Fax Number:
831-386-9841

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
809 BROADWAY ST
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
KING CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93930-3303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-386-7493
Provider Business Practice Location Address Fax Number:
831-386-9841
Provider Enumeration Date:
11/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SIGMUND
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
T.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
831-386-7493

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  2818999 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7858764 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0217526 . This is a "WASHINGTON STATE DOL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5681622 . This is a "CCN / FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: ZZZ66647Z . This is a "BLUE SHIELD OF CALIFORNIA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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