1265587422 NPI number — ADVANCED MULTI SPECIALTY MEDICAL GROUP

Table of content: (NPI 1265587422)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265587422 NPI number — ADVANCED MULTI SPECIALTY MEDICAL GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED MULTI SPECIALTY MEDICAL GROUP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
AS SOON AS POSSIBLE MEDICAL CENTER INC.
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265587422
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/26/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1460 150TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN LEANDRO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94578-1821
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-276-4845
Provider Business Mailing Address Fax Number:
510-276-8452

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
177 BUTCHER RD STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VACAVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95687-5656
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-451-7426
Provider Business Practice Location Address Fax Number:
707-451-2165
Provider Enumeration Date:
01/25/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
VAMVOURIS
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
510-276-4845

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 171100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)