Provider Demographics
NPI:1043264526
Name:MERCED ANES MEDICAL ASSOC
Entity type:Organization
Organization Name:MERCED ANES MEDICAL ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAMAKRISHNA
Authorized Official - Middle Name:
Authorized Official - Last Name:THONDAPU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-580-3400
Mailing Address - Street 1:PO BOX 7096
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95267
Mailing Address - Country:US
Mailing Address - Phone:209-956-7725
Mailing Address - Fax:209-956-7733
Practice Address - Street 1:1390 E YOSEMITE AVE
Practice Address - Street 2:STE B
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340
Practice Address - Country:US
Practice Address - Phone:209-580-3400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC16020OtherRAILROAD M CARE
CAGR0083930Medicaid
CAZZZ65749ZOtherBLUE SHIELD OF CA
CAZZZ15568ZMedicare ID - Type Unspecified
CAZZZ57796ZMedicare PIN