1023004850 NPI number — CONGRESS MEDICAL ASSOCIATES

Table of content: (NPI 1023004850)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023004850 NPI number — CONGRESS MEDICAL ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONGRESS MEDICAL ASSOCIATES
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:
CONGRESS ORTHOPAEDIC 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:
1023004850
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 90730
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91109-0730
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-795-8051
Provider Business Mailing Address Fax Number:
626-795-0356

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
289 W HUNTINGTON DR STE 103
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARCADIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91007-3492
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-821-0707
Provider Business Practice Location Address Fax Number:
626-509-1012
Provider Enumeration Date:
09/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
FRAIPONT
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
J
Authorized Official Title or Position:
MANAGING PARTNER
Authorized Official Telephone Number:
626-795-8051

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  G81716 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: W17086 . This is a "MEDICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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