Provider Demographics
NPI: | 1609409077 |
---|---|
Name: | ALTAMED HEALTH SERVICES CORP |
Entity Type: | Organization |
Organization Name: | ALTAMED HEALTH SERVICES CORP |
Other - Org Name: | ALTAMED HEALTH SERVICES PHARMACY WESTLAKE |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | VP, PATIENT FINANCIAL SERVICES |
Authorized Official - Prefix: | |
Authorized Official - First Name: | ROBERT |
Authorized Official - Middle Name: | U |
Authorized Official - Last Name: | YOUNG |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 323-622-2429 |
Mailing Address - Street 1: | 2040 CAMFIELD AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | LOS ANGELES |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 90040-1501 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 323-622-2429 |
Mailing Address - Fax: | 323-888-0220 |
Practice Address - Street 1: | 2100 W 3RD ST STE 190 |
Practice Address - Street 2: | |
Practice Address - City: | LOS ANGELES |
Practice Address - State: | CA |
Practice Address - Zip Code: | 90057-1999 |
Practice Address - Country: | US |
Practice Address - Phone: | 213-355-9840 |
Practice Address - Fax: | 323-853-6902 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2020-02-13 |
Last Update Date: | 2020-02-28 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 3336C0003X | Suppliers | Pharmacy | Community/Retail Pharmacy |