Provider Demographics
NPI:1174550412
Name:GIANGRECO MEDICAL GROUP
Entity type:Organization
Organization Name:GIANGRECO MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-322-1205
Mailing Address - Street 1:PO BOX 2332
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92263-2332
Mailing Address - Country:US
Mailing Address - Phone:760-322-1205
Mailing Address - Fax:760-778-5770
Practice Address - Street 1:1951 W 25TH ST
Practice Address - Street 2:SUITE F
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-6925
Practice Address - Country:US
Practice Address - Phone:928-314-1174
Practice Address - Fax:928-314-1175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ27310207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ65592Medicare ID - Type Unspecified