Provider Demographics
NPI:1467476002
Name:MEMORIAL PROMPT CARE MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:MEMORIAL PROMPT CARE MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:BARTON
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-891-9008
Mailing Address - Street 1:9122 ADAMS AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-3405
Mailing Address - Country:US
Mailing Address - Phone:714-962-1780
Mailing Address - Fax:714-962-5128
Practice Address - Street 1:9122 ADAMS AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92646-3405
Practice Address - Country:US
Practice Address - Phone:714-962-1780
Practice Address - Fax:714-962-5128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW11370Medicare PIN
CA0848180001Medicare NSC
CAW11370AMedicare PIN