Provider Demographics
NPI:1184651622
Name:ST. AUGUSTINE MEDICAL CENTER INC.
Entity Type:Organization
Organization Name:ST. AUGUSTINE MEDICAL CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:W
Authorized Official - Last Name:YU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-307-7397
Mailing Address - Street 1:210 N GARFIELD AVE
Mailing Address - Street 2:SUITE 212
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-1746
Mailing Address - Country:US
Mailing Address - Phone:626-307-7397
Mailing Address - Fax:626-307-1807
Practice Address - Street 1:210 N GARFIELD AVE
Practice Address - Street 2:SUITE 212
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-1746
Practice Address - Country:US
Practice Address - Phone:626-307-7397
Practice Address - Fax:626-307-1807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0080350Medicaid
CAGR0080350Medicaid