1255045134 NPI number — MICHAEL H. BISHOP DO A PROFESSIONAL MEDICAL CORPORATION

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255045134 NPI number — MICHAEL H. BISHOP DO A PROFESSIONAL MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHAEL H. BISHOP DO A 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:
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:
1255045134
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/05/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5753 E SANTA ANA CANYON RD STE G310
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:
92807-3230
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-258-6200
Provider Business Mailing Address Fax Number:
619-258-0028

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27110 BIG HORN MOUNTAIN WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YORBA LINDA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92887-4224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-258-6200
Provider Business Practice Location Address Fax Number:
619-258-0028
Provider Enumeration Date:
01/05/2023

Additional Information

Authorized Official

Authorized Official Last Name:
BISHOP
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
H
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
714-273-5687

Provider Taxonomy Codes

  • Taxonomy code: 207PE0005X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1497865364 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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