1184655797 NPI number — AMISUB IRVINE MEDICAL CENTER), INC.

Table of content: (NPI 1184655797)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184655797 NPI number — AMISUB IRVINE MEDICAL CENTER), INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMISUB IRVINE MEDICAL CENTER), 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:
Provider Other Organization Name Type Code:
6
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:
1184655797
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/18/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
FILE 57547
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90074-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-300-4122
Provider Business Mailing Address Fax Number:
949-753-2131

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16200 SAND CANYON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IRVINE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92618-3714
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-753-2000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ARMIN
Authorized Official First Name:
CRAIG
Authorized Official Middle Name:
C.
Authorized Official Title or Position:
VP OF GOVT PROGRAMS, TENET
Authorized Official Telephone Number:
818-436-2267

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  060000275 , 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: 8376 . This is a "HEALTH NET" identifier . This identifiers is of the category "OTHER".
  • Identifier: HSP40693F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004834-0001 . This is a "PACIFICARE OF CALIFORNIA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 295398770 . This is a "AETNA US HEALTHCARE (NATI" identifier . This identifiers is of the category "OTHER".
  • Identifier: ZZZA3025Z . This is a "BS OF CALIFORNIA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 55-5531 . This is a "BC OF CALIFORNIA" identifier . This identifiers is of the category "OTHER".
  • Identifier: HSP30693F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000417 . This is a "HUMANA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 050693B000000 . This is a "SECTION 1011" identifier . This identifiers is of the category "OTHER".




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