1265782890 NPI number — BEVERLY ONCOLOGY MULTISPECIALTY GROUP MEDCIAL CORPORATION

Table of content: (NPI 1265782890)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265782890 NPI number — BEVERLY ONCOLOGY MULTISPECIALTY GROUP MEDCIAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BEVERLY ONCOLOGY MULTISPECIALTY GROUP MEDCIAL 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:
BEVERLY ONCOLOGY MULTISPECIALTY GROUP
Provider Other Organization Name Type Code:
3
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:
1265782890
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/11/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 E BEVERLY BLVD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
MONTEBELLO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90640-7001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-517-9800
Provider Business Mailing Address Fax Number:
323-727-7574

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18575 GALE AVE
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
CITY OF INDUSTRY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91748-1340
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-810-6886
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/11/2012

Additional Information

Authorized Official

Authorized Official Last Name:
THROPAY
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
P
Authorized Official Title or Position:
MEDICAL DOCTOR
Authorized Official Telephone Number:
323-517-9800

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  G32178 , 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: 1396932943 . This is a "GROUP NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1720195977 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1184664377 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1396932943 . This is a "GENERAL NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1679760227 . This is a "NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1750302261 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1740350354 . This is a "GROUP NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1427128073 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1033306683 . This is a "NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1871663401 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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