Provider Demographics
NPI:1851335137
Name:A-MED HEALTH CARE CENTER
Entity Type:Organization
Organization Name:A-MED HEALTH CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:N
Authorized Official - Last Name:THACKER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:800-289-5476
Mailing Address - Street 1:5082 BOLSA AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-1065
Mailing Address - Country:US
Mailing Address - Phone:800-289-5476
Mailing Address - Fax:714-890-3810
Practice Address - Street 1:5082 BOLSA AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92649-1065
Practice Address - Country:US
Practice Address - Phone:800-289-5476
Practice Address - Fax:714-890-3810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100491332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY90052242Medicaid
CADME00250HMedicaid
IL953763705001Medicaid
CT3090793Medicaid
MT5604755Medicaid
CO98002595Medicaid
MI4574117Medicaid
IA931659Medicaid
HI55785301Medicaid
NC9198574017Medicaid
ID0002052Medicaid
AZ166993Medicaid
LA1990213Medicaid
OH958763Medicaid
AKMS476CAMedicaid
CO98002595Medicaid
CO98002595Medicaid