1942255195 NPI number — FCS MEDICAL CORPORATION

Table of content: (NPI 1942255195)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942255195 NPI number — FCS MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FCS MEDICAL 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:
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:
1942255195
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/16/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5823 YORK BLVD
Provider Second Line Business Mailing Address:
SUITE 3
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90042-2634
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-255-5643
Provider Business Mailing Address Fax Number:
323-255-2158

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1701 E CESAR CHAVEZ AVENUE
Provider Second Line Business Practice Location Address:
SUITE 230
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90033-2464
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-226-1100
Provider Business Practice Location Address Fax Number:
323-226-1101
Provider Enumeration Date:
05/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SAMANIEGO
Authorized Official First Name:
LUIS
Authorized Official Middle Name:
RAMON
Authorized Official Title or Position:
GROUP PRESIDENT
Authorized Official Telephone Number:
323-255-5643

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: W10759 . This is a "MEDICARE GROUP ID" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: GR0040670 . This is a "MEDICAID GROUP ID" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ22102Z . This is a "BLUE SHIELD GROUP ID" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: CQ2165 . This is a "MEDICARE RAILROAD GROUP" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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