1881944908 NPI number — EMERE MEDICAL PROFESSIONAL CORPORATION

Table of content: (NPI 1881944908)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881944908 NPI number — EMERE MEDICAL PROFESSIONAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMERE MEDICAL PROFESSIONAL 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:
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:
1881944908
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/16/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
801 N 500 W
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
BOUNTIFUL
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84010-6829
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-617-2100
Provider Business Mailing Address Fax Number:
801-208-7050

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24431 CALLE DE LA LOUISA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAGUNA HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92653-7641
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-610-1028
Provider Business Practice Location Address Fax Number:
949-610-1030
Provider Enumeration Date:
09/17/2012

Additional Information

Authorized Official

Authorized Official Last Name:
HUGHES
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
650-504-8151

Provider Taxonomy Codes

  • Taxonomy code: 2081S0010X , with the licence number:  A78391 , 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: A78391 . This is a "CALIFORNIA MEDICAL BOARD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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