Provider Demographics
NPI:1003520065
Name:FMC 26, PC
Entity Type:Organization
Organization Name:FMC 26, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOABB
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GRIPPO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-967-5670
Mailing Address - Street 1:14547 VICTORY BLVD
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-1619
Mailing Address - Country:US
Mailing Address - Phone:818-997-3232
Mailing Address - Fax:818-997-7750
Practice Address - Street 1:14547 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-1619
Practice Address - Country:US
Practice Address - Phone:818-997-3232
Practice Address - Fax:818-997-7750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty