# INDEPENDENCE MEDICAL GROUP OF CENTRAL CALIFORNIA, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Independence Medical Group
- **Organization subpart:** No

## Provider details

- **NPI number:** 1477796464
- **Authorized official:** CHARLES HABERKERN (VICE PRESIDENT)
- **Authorized official phone:** (661) 496-5638

## Contact information

- **Practice address:** 100 WILLOW PLZ, SUITE 405, VISALIA, CA 93291-6206
- **Practice address phone:** (559) 802-1105
- **Practice address fax:** (559) 750-4081
- **Mailing address:** 100 WILLOW PLZ, SUITE 405, VISALIA, CA 93291-6206
- **Mailing address phone:** (559) 802-1105
- **Mailing address fax:** (559) 750-4081

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302R00000X | Health Maintenance Organization | — | NULL | Yes |

## Other

- **Enumeration date:** 04/07/2009
- **Last updated:** 04/07/2009