1306248240 NPI number — PACIFIC HOSPITALIST ASSOCIATES A MEDICAL CORPORATION

Table of content: (NPI 1306248240)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306248240 NPI number — PACIFIC HOSPITALIST ASSOCIATES A MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PACIFIC HOSPITALIST ASSOCIATES A MEDICAL CORPORATION
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:
PACIFIC HOSPITALIST ASSOCIATES
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:
1306248240
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/09/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
361 HOSPITAL RD STE 521
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWPORT BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92663-3526
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-873-5181
Provider Business Mailing Address Fax Number:
949-873-0418

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1555 SUPERIOR AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWPORT BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92663-3628
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-646-7764
Provider Business Practice Location Address Fax Number:
949-574-5633
Provider Enumeration Date:
09/23/2014

Additional Information

Authorized Official

Authorized Official Last Name:
CHANDLER
Authorized Official First Name:
WESTON
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
949-610-7245

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  FNP28511 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CK2215 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: W15241 . This is a "MEDICARE PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com