Provider Demographics
NPI:1184655797
Name:AMISUB IRVINE MEDICAL CENTER), INC.
Entity Type:Organization
Organization Name:AMISUB IRVINE MEDICAL CENTER), INC.
Other - Org Name:IRVINE MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF GOVT PROGRAMS, TENET
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:C
Authorized Official - Last Name:ARMIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-436-2267
Mailing Address - Street 1:FILE 57547
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-0001
Mailing Address - Country:US
Mailing Address - Phone:626-300-4122
Mailing Address - Fax:949-753-2131
Practice Address - Street 1:16200 SAND CANYON AVE
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3714
Practice Address - Country:US
Practice Address - Phone:949-753-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA060000275282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
8376OtherHEALTH NET
CAHSP40693FMedicaid
004834-0001OtherPACIFICARE OF CALIFORNIA
295398770OtherAETNA US HEALTHCARE (NATI
ZZZA3025ZOtherBS OF CALIFORNIA
55-5531OtherBC OF CALIFORNIA
CAHSP30693FMedicaid
000417OtherHUMANA
050693B000000OtherSECTION 1011
050693B000000OtherSECTION 1011