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Organization
ST JUDE EMERGENCY MEDICAL GROUP INC
Active
Organization
ST JUDE EMERGENCY MEDICAL GROUP INC
Active
Other names
St Jude Emergency Medicine Group Inc
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD J. GRECO MD (PRESIDENT)
(949) 300-9287
Entity
Organization
Contact information
Practice address
101 E VALENCIA MESA DR, EM DEPT, FULLERTON, CA 92835-3809
(949) 300-9287
Mailing address
PO BOX 80380, CITY OF INDUSTRY, CA 91716-8380
(844) 488-7184
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CR0096
RR MEDICARE
CA
01
—
GR0042730
CALOPTIMA
CA
05
—
GR0042730
—
CA
01
—
ZZZ22082Z
BLUE SHIELD
CA
Enumeration date
08/31/2006
Last updated
06/04/2024
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