Provider Demographics
NPI:1073210621
Name:911 MEDHEALTH
Entity Type:Organization
Organization Name:911 MEDHEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:FARZAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-878-9111
Mailing Address - Street 1:701 SANTA MONICA BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-2624
Mailing Address - Country:US
Mailing Address - Phone:714-905-6099
Mailing Address - Fax:
Practice Address - Street 1:701 SANTA MONICA BLVD STE 300
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-2624
Practice Address - Country:US
Practice Address - Phone:714-905-6099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-14
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center