1336538321 NPI number — NATIONWIDE MEDICAL, INC

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 1336538321 NPI number — NATIONWIDE MEDICAL, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NATIONWIDE MEDICAL, 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:
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:
1336538321
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/14/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
29901 AGOURA RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AGOURA HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91301-2513
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-338-3500
Provider Business Mailing Address Fax Number:
818-338-3501

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5113 HIGHWAY 58
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
CHATTANOOGA
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37416-1665
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-338-3500
Provider Business Practice Location Address Fax Number:
818-338-3501
Provider Enumeration Date:
01/14/2015

Additional Information

Authorized Official

Authorized Official Last Name:
SIEGEL
Authorized Official First Name:
HOWARD
Authorized Official Middle Name:
Authorized Official Title or Position:
CHAIRMAN/MAJORITY OWNER
Authorized Official Telephone Number:
818-338-3500

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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