Provider Demographics
NPI:1568437440
Name:AMDC
Entity Type:Organization
Organization Name:AMDC
Other - Org Name:CATALINA ISLAND MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FRAZE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-510-0700
Mailing Address - Street 1:PO BOX 3699
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92659-8699
Mailing Address - Country:US
Mailing Address - Phone:949-857-1248
Mailing Address - Fax:949-559-1165
Practice Address - Street 1:4870 BARRANCA PKWY
Practice Address - Street 2:SUITE 110
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-4709
Practice Address - Country:US
Practice Address - Phone:949-857-1248
Practice Address - Fax:949-559-1165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69508207Q00000X, 261Q00000X, 282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Not Answered261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Not Answered282NR1301XHospitalsGeneral Acute Care HospitalRuralGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA69508OtherCALIF STATE MEDICAL LIC
CAA69508OtherCALIF STATE MEDICAL LIC
CAH48191Medicare UPIN