Provider Demographics
NPI:1699845081
Name:ADVANTAGE CARE IPA
Entity Type:Organization
Organization Name:ADVANTAGE CARE IPA
Other - Org Name:ADVANTAGE CARE IPA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:INFORMATION SYSTEMS DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:W
Authorized Official - Last Name:KIRBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-388-2300
Mailing Address - Street 1:1540 BRIDGEGATE DR
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-3912
Mailing Address - Country:US
Mailing Address - Phone:626-388-2300
Mailing Address - Fax:626-388-2317
Practice Address - Street 1:1540 BRIDGEGATE DR
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-3912
Practice Address - Country:US
Practice Address - Phone:626-388-2300
Practice Address - Fax:626-388-2317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization