Provider Demographics
NPI:1942976790
Name:HOSPITAL MED ASSIST
Entity Type:Organization
Organization Name:HOSPITAL MED ASSIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:IAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FISCHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-417-1127
Mailing Address - Street 1:HOSPITAL MED ASSIST
Mailing Address - Street 2:1779 KIRBY PKWY #12480 MEMPHIS, TN
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38138
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:MANUEL M. DIEGUEZ 360
Practice Address - Street 2:MEXICO
Practice Address - City:PUERTO VALLARTA
Practice Address - State:MEXICIO
Practice Address - Zip Code:48380
Practice Address - Country:MX
Practice Address - Phone:650-417-1127
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-20
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LSE140616QY2OtherTAX
LSE140616QY3OtherTAX