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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