Provider Demographics
NPI:1235376047
Name:ALTAMED HEALTH SERVICES CORP
Entity Type:Organization
Organization Name:ALTAMED HEALTH SERVICES CORP
Other - Org Name:ALTAMED MEDICAL GROUP-ANAHEIM LINCOLN, WEST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP, PATIENT FINANCIAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:U
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-622-2429
Mailing Address - Street 1:2040 CAMFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90040-1501
Mailing Address - Country:US
Mailing Address - Phone:714-635-0593
Mailing Address - Fax:714-563-9142
Practice Address - Street 1:1820 W LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-6730
Practice Address - Country:US
Practice Address - Phone:714-635-0593
Practice Address - Fax:714-563-9142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-15
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA551029Medicare Oscar/Certification