Provider Demographics
NPI:1043428188
Name:PRIVATE PHYSICIANS MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:PRIVATE PHYSICIANS MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VANMETER
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:LAWRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-379-8585
Mailing Address - Street 1:520 SUPERIOR AVE
Mailing Address - Street 2:SUITE 285
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3637
Mailing Address - Country:US
Mailing Address - Phone:949-566-8179
Mailing Address - Fax:888-565-6545
Practice Address - Street 1:520 SUPERIOR AVE
Practice Address - Street 2:SUITE 285
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3637
Practice Address - Country:US
Practice Address - Phone:949-566-8179
Practice Address - Fax:888-565-6545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW16172Medicare ID - Type Unspecified