1982673398 NPI number — ANALYTIC PATHOLOGY MEDICAL GROUP

Table of content: (NPI 1982673398)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982673398 NPI number — ANALYTIC PATHOLOGY MEDICAL GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANALYTIC PATHOLOGY MEDICAL GROUP
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:
1982673398
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 10076
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VAN NUYS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91410-0076
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-578-8950
Provider Business Mailing Address Fax Number:
805-578-8950

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1415 ROSS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EL CENTRO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92243-4306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-740-4492
Provider Business Practice Location Address Fax Number:
619-740-4418
Provider Enumeration Date:
03/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CARRY
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
B
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
760-339-7100

Provider Taxonomy Codes

  • Taxonomy code: 207ZC0500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZP0102X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: GR0092920 . This is a "DHS GROUP ID" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ46835Z . This is a "BLUE SHIELD GROUP ID" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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