Provider Demographics
NPI:1043264625
Name:CENTURY EMERGENCY MEDICAL GRP
Entity Type:Organization
Organization Name:CENTURY EMERGENCY MEDICAL GRP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:V
Authorized Official - Last Name:PAGANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-599-6811
Mailing Address - Street 1:PO BOX 4419
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91365-4419
Mailing Address - Country:US
Mailing Address - Phone:800-358-9787
Mailing Address - Fax:818-587-2493
Practice Address - Street 1:1350 W COVINA BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-3245
Practice Address - Country:US
Practice Address - Phone:909-599-6811
Practice Address - Fax:818-587-2493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACC9167OtherRAILROAD MEDICARE
CAGR0066611Medicaid
CAGR0066610Medicaid
CAZZZ47634ZOtherBLUE SHIELD
CAZZZ52054ZOtherBLUE SHIELD
CAGR0066611Medicaid