1245292358 NPI number — FCMS CORPORATION

Table of content: JILL MOORE ARNOLD PAC (NPI 1255300430)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245292358 NPI number — FCMS CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FCMS 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:
6
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:
1245292358
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1700 N LOMBARD STREET
Provider Second Line Business Mailing Address:
3RD FL
Provider Business Mailing Address City Name:
OXNARD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93030
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-485-3277
Provider Business Mailing Address Fax Number:
805-988-1367

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1751 N LOMBARD STREET
Provider Second Line Business Practice Location Address:
#C
Provider Business Practice Location Address City Name:
OXNARD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-485-0331
Provider Business Practice Location Address Fax Number:
805-988-1367
Provider Enumeration Date:
04/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WALSKI
Authorized Official First Name:
ROBERTA
Authorized Official Middle Name:
TERI
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
805-604-1211

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X , with the licence number:  8RYAR99701986 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , with the licence number: 8RYAR99701986 , 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: DME02070F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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