Organization
MERCED ORTHOPAEDIC MEDICAL GROUP, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SAMUEL B TACKE MD (MD)
(209) 722-8161
Entity
Organization
Contact information
Practice address
123 W NORTH BEAR CREEK DR, MERCED, CA 95348-3420
(209) 722-8161
Mailing address
123 W NORTH BEAR CREEK DRIVE, MERCED, CA 95348
(209) 722-8161
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZZZ48011Z
—
CA
Enumeration date
07/07/2005
Last updated
07/21/2022
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