# MERCED ORTHOPAEDIC MEDICAL GROUP, INC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1326046012
- **Authorized official:** DR. SAMUEL B TACKE MD (MD)
- **Authorized official phone:** (209) 722-8161

## Contact information

- **Practice address:** 123 W NORTH BEAR CREEK DR, MERCED, CA 95348-3420
- **Practice address phone:** (209) 722-8161
- **Mailing address:** 123 W NORTH BEAR CREEK DRIVE, MERCED, CA 95348
- **Mailing address phone:** (209) 722-8161

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | — | CA | Yes |

## Other

- **Enumeration date:** 07/07/2005
- **Last updated:** 07/21/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | ZZZ48011Z | — | CA |