1992733513 NPI number — EMANATE HEALTH FOOTHILL PRESBYTERIAN HOSPITAL

Table of content: (NPI 1992733513)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992733513 NPI number — EMANATE HEALTH FOOTHILL PRESBYTERIAN HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMANATE HEALTH FOOTHILL PRESBYTERIAN HOSPITAL
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:
FOOTHILL PRESBYTERIAN HOSPITAL
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:
1992733513
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/27/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 840149
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90084-0149
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-732-3100
Provider Business Mailing Address Fax Number:
626-732-3195

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:
626-963-8411
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SHARMA
Authorized Official First Name:
ROGER
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE VP/CFO
Authorized Official Telephone Number:
626-938-7595

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: ZZT40597F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: HSC30597F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1026 . This is a "BLUE CROSS SO CAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZT30597F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZZA1988Z . This is a "BLUE SHIELD CA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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