Provider Demographics
NPI:1023638814
Name:FAMILY MEDICINE AND AMBULATORY CARE
Entity type:Organization
Organization Name:FAMILY MEDICINE AND AMBULATORY CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BILLING
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:ONEILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-677-1112
Mailing Address - Street 1:PO BOX 4345
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-0017
Mailing Address - Country:US
Mailing Address - Phone:530-677-1112
Mailing Address - Fax:530-677-1190
Practice Address - Street 1:6600 MERCY CT STE 100
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-3154
Practice Address - Country:US
Practice Address - Phone:916-967-7285
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-21
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty