Provider Demographics
NPI:1740214733
Name:EMERGENCY MEDICINE SPECIALISTS OF ORANGE COUNTY
Entity Type:Organization
Organization Name:EMERGENCY MEDICINE SPECIALISTS OF ORANGE COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:MULLARKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-543-8911
Mailing Address - Street 1:1310 W STEWART DR STE 212
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3837
Mailing Address - Country:US
Mailing Address - Phone:714-543-8911
Mailing Address - Fax:714-543-8914
Practice Address - Street 1:1100 WEST STEWART DR
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3849
Practice Address - Country:US
Practice Address - Phone:714-633-9111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0044120Medicaid
CAHW11028Medicare PIN