Provider Demographics
NPI:1518494541
Name:EMPIRE HEALTH SYSTEMS
Entity Type:Organization
Organization Name:EMPIRE HEALTH SYSTEMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPHINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:862-252-0531
Mailing Address - Street 1:7028 OAKCREST CT
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-2072
Mailing Address - Country:US
Mailing Address - Phone:862-252-0531
Mailing Address - Fax:760-418-6486
Practice Address - Street 1:15995 TUSCOLA RD STE 203
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2159
Practice Address - Country:US
Practice Address - Phone:862-252-0531
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-22
Last Update Date:2017-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty