1508897752 NPI number — ARCADIA PRIMARY CARE PHYSICIANS MEDICAL CORPORATION

Table of content: (NPI 1508897752)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508897752 NPI number — ARCADIA PRIMARY CARE PHYSICIANS MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARCADIA PRIMARY CARE PHYSICIANS 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:
ARCADIA FAMILY PHYSICIANS
Provider Other Organization Name Type Code:
4
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:
1508897752
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/28/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1505 S BALDWIN AVE # B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARCADIA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91007-7925
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-445-1556
Provider Business Mailing Address Fax Number:
626-574-9059

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1505 S BALDWIN AVE # B
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:
91007-7925
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-445-1556
Provider Business Practice Location Address Fax Number:
626-574-9059
Provider Enumeration Date:
07/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HO
Authorized Official First Name:
GLENN
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
626-445-1556

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  A38922 , 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: 00A389220 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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