1962599183 NPI number — PRIMARY AND MULTI-SPECIALTY CLINICS OF ANAHEIM, INC

Table of content: (NPI 1962599183)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962599183 NPI number — PRIMARY AND MULTI-SPECIALTY CLINICS OF ANAHEIM, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRIMARY AND MULTI-SPECIALTY CLINICS OF ANAHEIM, 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:
GATEWAY MEDICAL CENTER-ANAHEIM HILLS
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:
1962599183
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
710 N EUCLID ST STE 400
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANAHEIM
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92801-4131
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-517-2019
Provider Business Mailing Address Fax Number:
714-490-1975

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 S ANAHEIM HILLS RD
Provider Second Line Business Practice Location Address:
SUITE 230
Provider Business Practice Location Address City Name:
ANAHEIM
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92807-4780
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-974-2820
Provider Business Practice Location Address Fax Number:
714-974-1539
Provider Enumeration Date:
10/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LEW
Authorized Official First Name:
MITCHELL
Authorized Official Middle Name:
W
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
714-517-2000

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RA0201X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: GR0099850 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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