1982650271 NPI number — SOUTH BAY EMERGENCY MEDICAL ASSOCIATES

Table of content: (NPI 1982650271)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982650271 NPI number — SOUTH BAY EMERGENCY MEDICAL ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTH BAY EMERGENCY MEDICAL ASSOCIATES
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:
1982650271
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/26/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 N SEPULVEDA BLVD
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
MANHATTAN BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90266-6861
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-379-2134
Provider Business Mailing Address Fax Number:
310-379-4856

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2740 M ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MERCED
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95340-2813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-384-6480
Provider Business Practice Location Address Fax Number:
209-384-6710
Provider Enumeration Date:
05/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BELL
Authorized Official First Name:
MARK
Authorized Official Middle Name:
ROBERT
Authorized Official Title or Position:
MANAGING PARTNER
Authorized Official Telephone Number:
310-379-2134

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , 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: GR0068932 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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