# PEACHWOOD MEDICAL GROUP CLOVIS INC

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

## Provider details

- **NPI number:** 1831170745
- **Authorized official:** MR. LEE ROY COPELAND M.D. (PRESIDENT)
- **Authorized official phone:** (559) 324-6200

## Contact information

- **Practice address:** 275 W HERNDON AVE, CLOVIS, CA 93612-0204
- **Practice address phone:** (559) 324-6200
- **Practice address fax:** (559) 324-6280
- **Mailing address:** 275 W HERNDON AVE, CLOVIS, CA 93612-0204
- **Mailing address phone:** (559) 324-6200
- **Mailing address fax:** (559) 324-6280

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | — |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | — |
| 208000000X | Pediatrics Physician | — | NULL | — |
| 208000000X | Pediatrics Physician | — | — | — |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |
| 261QU0200X | Urgent Care Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 11/08/2005
- **Last updated:** 03/23/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | GR0066590 | — | CA |