Organization
MERCED FACULTY ASSOCIATES MEDICAL GROUP INCORPORATED
Active
Other names
MFA Medical Group Gateway Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
REBECCA SHAW (CEO)
(209) 723-1920
Entity
Organization
Contact information
Practice address
378 W OLIVE AVE, SUITE D, MERCED, CA 95348-3182
(209) 725-7560
(209) 725-7561
Mailing address
PO BOX 3768, MERCED, CA 95344-3768
(209) 725-7149
(209) 726-0259
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CS1342
RAILROAD MEDICARE
GA
05
—
GR0041481
MEDI-CAL GROUP NUMBER
CA
01
—
ZZZ09267Z
BLUE SHIELD GROUP NUMBER
CA
Enumeration date
07/13/2007
Last updated
07/15/2014
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