Freedom Park Medical Services A Medical Corporation
Emergency Medicine in Ridgecrest, CA. Organization (NPI-2).
NPI number1679066476
StatusActive
Last updated in NPPESOct 28, 2019
Details
- NPI
- 1679066476
- Entity type
- Organization (NPI-2)
- Legal business name
- Freedom Park Medical Services A Medical Corporation
- Organization subpart
- No
- Enumeration date
- Jun 7, 2018
- Last updated
- Oct 28, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207P00000X | Emergency Medicine | – | – | Yes |
Practice location
1081 N China Lake BlvdRidgecrest, CA 93555-3130
Phone 469-401-2386
Mailing address
Po Box 99103Las Vegas, NV 89193-9085
Phone 954-838-2371
Authorized official
Kathleen Kondas
Vp Provider Enrollment
9732511132
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