Organization
PROVIDENT PRIMARY CARE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JERRY TIU (CEO)
(209) 384-4400
Entity
Organization
Contact information
Practice address
3349 G ST STE C, MERCED, CA 95340-0978
(209) 580-4638
(209) 580-4163
Mailing address
3349 G ST STE C, MERCED, CA 95340-0978
(209) 384-4400
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
—
—
213E00000X
Podiatrist
—
—
261QP2300X
Primary Care Clinic/Center
Primary
—
—
363LP2300X
Primary Care Nurse Practitioner
—
—
Other
Enumeration date
04/11/2016
Last updated
10/12/2021
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