1366455875 NPI number — MARATHON MEDICAL GROUP INC

Table of content: DR. JAMES SPENCER SAVAGE PHARMD (NPI 1407475171)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366455875 NPI number — MARATHON MEDICAL GROUP INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARATHON MEDICAL GROUP 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:
1366455875
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/20/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 S ANAHEIM HILLS RD
Provider Second Line Business Mailing Address:
STE 206
Provider Business Mailing Address City Name:
ANAHEIM HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92807
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-282-6934
Provider Business Mailing Address Fax Number:
714-282-6935

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:
STE 206
Provider Business Practice Location Address City Name:
ANAHEIM HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92807
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-282-6934
Provider Business Practice Location Address Fax Number:
714-282-6935
Provider Enumeration Date:
08/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FRISCH
Authorized Official First Name:
DONNA
Authorized Official Middle Name:
JO
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
714-282-6934

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  G76025 , 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: W16596 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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