Provider Demographics
NPI:1497123194
Name:ARROWHEAD REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:ARROWHEAD REGIONAL MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PA-C
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:TANKERSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-580-1000
Mailing Address - Street 1:14 ESTY WAY
Mailing Address - Street 2:
Mailing Address - City:GROVELAND
Mailing Address - State:MA
Mailing Address - Zip Code:01834-1063
Mailing Address - Country:US
Mailing Address - Phone:978-490-7319
Mailing Address - Fax:
Practice Address - Street 1:400 NORTH PEPPER AVE
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324
Practice Address - Country:US
Practice Address - Phone:909-580-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-11
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital