Provider Demographics
NPI:1487739942
Name:CAMERON PARK MEDICAL GROUP
Entity type:Organization
Organization Name:CAMERON PARK MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:L
Authorized Official - Last Name:MINGLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-676-7337
Mailing Address - Street 1:3581 PALMER DR
Mailing Address - Street 2:STE. 401
Mailing Address - City:CAMERON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:95682-8236
Mailing Address - Country:US
Mailing Address - Phone:530-676-7337
Mailing Address - Fax:530-676-1141
Practice Address - Street 1:3581 PALMER DR
Practice Address - Street 2:STE. 401
Practice Address - City:CAMERON PARK
Practice Address - State:CA
Practice Address - Zip Code:95682-8236
Practice Address - Country:US
Practice Address - Phone:530-676-7337
Practice Address - Fax:530-676-1141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG52556208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty