Provider Demographics
NPI:1881847424
Name:ADVANCE URGENT MEDICAL GROUP INC
Entity Type:Organization
Organization Name:ADVANCE URGENT MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DARA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAGHAFI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-542-9700
Mailing Address - Street 1:1401 W 1ST ST
Mailing Address - Street 2:STE. 101
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92703-3757
Mailing Address - Country:US
Mailing Address - Phone:714-542-9700
Mailing Address - Fax:
Practice Address - Street 1:1401 W 1ST ST
Practice Address - Street 2:STE. 101
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92703-3757
Practice Address - Country:US
Practice Address - Phone:714-542-9700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76958302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1184821464OtherGROUP RENDERING PROVIDER L NUMBER
CA1942417365OtherGROUP RENDERING PROVIDER NUMBER
CA1144320672OtherGROUP RENDERING PROVIDER
CA1487834016OtherGROUP RENDERING PROVIDER NUMBER