Provider Demographics
NPI:1306180419
Name:EPIC HEALTH PLAN
Entity Type:Organization
Organization Name:EPIC HEALTH PLAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF BUSINESS DEVELOPMENT
Authorized Official - Prefix:
Authorized Official - First Name:DUANE
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITTINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-478-5109
Mailing Address - Street 1:10393 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-4525
Mailing Address - Country:US
Mailing Address - Phone:909-478-5109
Mailing Address - Fax:
Practice Address - Street 1:10393 ENTERPRISE DR
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-4525
Practice Address - Country:US
Practice Address - Phone:909-478-5109
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization