Provider Demographics
NPI:1619923653
Name:MOUNTAIN VIEW EMERGENCY PHYSICIANS MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:MOUNTAIN VIEW EMERGENCY PHYSICIANS MEDICAL GROUP, INC.
Other - Org Name:MOUNTAIN VIEW EMERGENCY PHYSICIANS MED GRP, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:BOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-985-2811
Mailing Address - Street 1:PO BOX 4419
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91365-4419
Mailing Address - Country:US
Mailing Address - Phone:877-484-3035
Mailing Address - Fax:818-587-2493
Practice Address - Street 1:999 SAN BERNARDINO RD
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4920
Practice Address - Country:US
Practice Address - Phone:909-985-2811
Practice Address - Fax:818-587-2493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0055090Medicaid
CACC8615OtherRAILROAD MEDICARE
CAZZZ36334ZOtherBLUE SHIED
CAZZZ36334ZMedicare ID - Type Unspecified