Organization
MERCED FACULTY ASSOCIATES MEDICAL GROUP INCORPORATED
Active
Organization
MERCED FACULTY ASSOCIATES MEDICAL GROUP INCORPORATED
Active
Other names
El Portal Endosurgery Center
Organization subpart
No
Provider details
NPI number
Authorized official
REBECCA L SHAW (CEO)
(209) 723-1920
Entity
Organization
Contact information
Practice address
3365 G ST, SUITE 101, MERCED, CA 95340-0994
(209) 205-1086
(209) 383-2811
Mailing address
PO BOX 3768, MERCED, CA 95344-3768
(209) 725-7149
(209) 726-0259
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
—
—
261QE0800X
Endoscopy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZH2406Z
BLUE SHIELD PIN
CA
Enumeration date
06/30/2006
Last updated
07/21/2014
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