1184655797 NPI number — AMISUB IRVINE MEDICAL CENTER), INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184655797 NPI number — AMISUB IRVINE MEDICAL CENTER), INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMISUB IRVINE MEDICAL CENTER), INC.
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:
IRVINE MEDICAL CENTER
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:
1184655797
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/18/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
FILE 57547
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:
90074-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-300-4122
Provider Business Mailing Address Fax Number:
949-753-2131

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16200 SAND CANYON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IRVINE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92618-3714
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-753-2000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ARMIN
Authorized Official First Name:
CRAIG
Authorized Official Middle Name:
C.
Authorized Official Title or Position:
VP OF GOVT PROGRAMS, TENET
Authorized Official Telephone Number:
818-436-2267

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  060000275 , 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: 8376 . This is a "HEALTH NET" identifier . This identifiers is of the category "OTHER".
  • Identifier: HSP40693F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004834-0001 . This is a "PACIFICARE OF CALIFORNIA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 295398770 . This is a "AETNA US HEALTHCARE (NATI" identifier . This identifiers is of the category "OTHER".
  • Identifier: ZZZA3025Z . This is a "BS OF CALIFORNIA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 55-5531 . This is a "BC OF CALIFORNIA" identifier . This identifiers is of the category "OTHER".
  • Identifier: HSP30693F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000417 . This is a "HUMANA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 050693B000000 . This is a "SECTION 1011" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com