Provider Demographics
NPI:1447288345
Name:TEAM PHYSICIANS OF CALIFORNIA MEDICAL GROUP INC
Entity type:Organization
Organization Name:TEAM PHYSICIANS OF CALIFORNIA MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR PROVIDER ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-251-6901
Mailing Address - Street 1:PO BOX 634600
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-4600
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1401 GARCES HWY
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:CA
Practice Address - Zip Code:93215-3690
Practice Address - Country:US
Practice Address - Phone:925-924-1600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADD4942OtherTULARE RAILROAD
CAZZZ65040ZOtherTULARE BLUE SHIELD
CACG0978OtherLA COMMUNITY RAILROAD
CAZZZ03631ZOtherDELANO BLUE SHIELD
CADD4942OtherDELANO RAILROAD
CAGR0083247Medicaid
CAZZZ002402OtherLA COMMUNITY BLUE SHIELD
CAGR008324GMedicaid
CAGR0083246Medicaid
CAGR008324EMedicaid
CAGR008324HMedicaid
CAGR008324HMedicaid
CAZZZ30383ZMedicare PIN