| Providence Family Practice Medical Group | |
|
1213 Coffee Rd Suite B Modesto CA 95355-4229 | |
| (209) 491-2500 | |
| (209) 491-2545 |
| Full Name | Providence Family Practice Medical Group |
|---|---|
| Speciality | Family Medicine |
| Location | 1213 Coffee Rd, Modesto, California |
| Authorized Official Name and Position | Kathie Lee Cronin (MANAGING PARTNER) |
| Authorized Official Contact | 2094912500 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Family Practice Medical Group 1213 Coffee Rd Suite B Modesto CA 95355-4229 Ph: (209) 491-2500 | Providence Family Practice Medical Group 1213 Coffee Rd Suite B Modesto CA 95355-4229 Ph: (209) 491-2500 |
| NPI Number | 1104979582 |
|---|---|
| Provider Enumeration Date | 01/19/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104979582 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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