Provider Demographics
NPI:1487748422
Name:HEGWOOD MEDICAL GROUP PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:HEGWOOD MEDICAL GROUP PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CORPORATION
Authorized Official - Prefix:
Authorized Official - First Name:TEKI
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:HEGWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:831-649-6201
Mailing Address - Street 1:880 CASS ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-2947
Mailing Address - Country:US
Mailing Address - Phone:831-649-9000
Mailing Address - Fax:831-649-9004
Practice Address - Street 1:337 EL DORADO ST
Practice Address - Street 2:SUITE A1
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-4647
Practice Address - Country:US
Practice Address - Phone:831-649-6201
Practice Address - Fax:831-649-3158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ31396ZMedicare ID - Type Unspecified