Provider Demographics
NPI:1508897752
Name:ARCADIA PRIMARY CARE PHYSICIANS MEDICAL CORPORATION
Entity Type:Organization
Organization Name:ARCADIA PRIMARY CARE PHYSICIANS MEDICAL CORPORATION
Other - Org Name:ARCADIA FAMILY PHYSICIANS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:HO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-445-1556
Mailing Address - Street 1:1505 S BALDWIN AVE # B
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-7925
Mailing Address - Country:US
Mailing Address - Phone:626-445-1556
Mailing Address - Fax:626-574-9059
Practice Address - Street 1:1505 S BALDWIN AVE # B
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-7925
Practice Address - Country:US
Practice Address - Phone:626-445-1556
Practice Address - Fax:626-574-9059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38922207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A389220Medicaid
CA00A389220Medicaid
CAA28758Medicare UPIN