1043264625 NPI number — CENTURY EMERGENCY MEDICAL GRP

Table of content: (NPI 1043264625)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043264625 NPI number — CENTURY EMERGENCY MEDICAL GRP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTURY EMERGENCY MEDICAL GRP
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:
1043264625
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:
PO BOX 4419
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOODLAND HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91365-4419
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-358-9787
Provider Business Mailing Address Fax Number:
818-587-2493

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1350 W COVINA BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIMAS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91773-3245
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-599-6811
Provider Business Practice Location Address Fax Number:
818-587-2493
Provider Enumeration Date:
05/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PAGANO
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
V
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
909-599-6811

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CC9167 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: GR0066611 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: GR0066610 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZZ47634Z . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ52054Z . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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