1851335137 NPI number — A-MED HEALTH CARE CENTER

Table of content: (NPI 1851335137)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851335137 NPI number — A-MED HEALTH CARE CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
A-MED HEALTH CARE CENTER
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:
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:
1851335137
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5082 BOLSA AVE
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
HUNTINGTON BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92649-1065
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-289-5476
Provider Business Mailing Address Fax Number:
714-890-3810

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5082 BOLSA AVE
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
HUNTINGTON BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92649-1065
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-289-5476
Provider Business Practice Location Address Fax Number:
714-890-3810
Provider Enumeration Date:
06/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
THACKER
Authorized Official First Name:
LARRY
Authorized Official Middle Name:
N
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
800-289-5476

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  100491 , 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: 90052242 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: DME00250H , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 953763705001 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3090793 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5604755 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 98002595 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4574117 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 931659 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 55785301 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9198574017 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0002052 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 166993 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1990213 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 958763 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: MS476CA , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".




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