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Organization
MERCED FACULTY ASSOCIATES MEDICAL GROUP INCORPORATED
Active
Organization
MERCED FACULTY ASSOCIATES MEDICAL GROUP INCORPORATED
Active
Other names
MFA Atwater
Organization subpart
No
Provider details
NPI number
Authorized official
REBECCA SHAW (CEO)
(209) 725-7149
Entity
Organization
Contact information
Practice address
1675 SHAFFER RD, ATWATER, CA 95301-4456
(209) 383-5500
(209) 383-6910
Mailing address
PO BOX 3768, MERCED, CA 95344-3768
(209) 725-7149
(209) 726-0259
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CS1342
RAILROAD MEDICARE
GA
05
—
GR0041484
—
CA
01
—
ZZZ61444Z
BLUE SHIELD GROUP NUMBER
CA
Enumeration date
07/04/2007
Last updated
04/30/2019
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