Provider Demographics
NPI:1093860314
Name:ALL CARE MEDICAL GROUP INC
Entity Type:Organization
Organization Name:ALL CARE MEDICAL GROUP INC
Other - Org Name:PROFESSIONAL SERVICES MEDICAL GROUP INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-589-6681
Mailing Address - Street 1:2675 E SLAUSON AVENUE
Mailing Address - Street 2:PROFESSIONAL SERVICES MEDICAL GROUP INC
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255
Mailing Address - Country:US
Mailing Address - Phone:323-589-6681
Mailing Address - Fax:323-589-4903
Practice Address - Street 1:2675 E SLAUSON AVENUE
Practice Address - Street 2:PROFESSIONAL SERVICES MEDICAL GROUP INC
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255
Practice Address - Country:US
Practice Address - Phone:323-589-6681
Practice Address - Fax:323-589-4903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0029130Medicaid
CAGR0029133Medicaid
CAGR0029131Medicaid
CAGR0029133Medicaid
CAGR0029131Medicaid