1598093262 NPI number — EASTERN MEDICAL CENTER PROFESSIONAL MEDICAL CORPORATION

Table of content: (NPI 1598093262)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598093262 NPI number — EASTERN MEDICAL CENTER PROFESSIONAL MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EASTERN MEDICAL CENTER PROFESSIONAL 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:
EASTERN MEDICAL CENTER
Provider Other Organization Name Type Code:
5
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:
1598093262
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/23/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2930 EASTERN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95821-4210
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-972-8966
Provider Business Mailing Address Fax Number:
916-972-8916

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2930 EASTERN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95821-4210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-972-8966
Provider Business Practice Location Address Fax Number:
916-972-8916
Provider Enumeration Date:
11/18/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LI
Authorized Official First Name:
LI
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
916-972-8966

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  A65618 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X , with the licence number: A83360 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X , with the licence number: A73749 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1134230220 . This is a "NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1912973520 . This is a "NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1710959523 . This is a "NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".