1699724732 NPI number — CALIFORNIA EM-I MEDICAL SERVICES, A MEDICAL CORPORATION

Table of content: (NPI 1699724732)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699724732 NPI number — CALIFORNIA EM-I MEDICAL SERVICES, A MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CALIFORNIA EM-I MEDICAL SERVICES, 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:
Provider Other Organization Name Type Code:
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:
1699724732
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/31/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13737 NOEL RD STE 1600
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75240-1374
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
469-401-2386
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
250 S GRAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLENDORA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91741-4218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
469-401-2386
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/08/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SLEPIN
Authorized Official First Name:
MARK
Authorized Official Middle Name:
J
Authorized Official Title or Position:
DIRECTOR/OFFICER
Authorized Official Telephone Number:
469-401-2386

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: GR008390E , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZZ61145Z . This is a "BLUE SHIELD OF CALIFORNIA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1699724732 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: CF9654 . This is a "RAILROAD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".