Provider Demographics
NPI:1952076630
Name:ANTHONY MARTIN MILLS M D A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:ANTHONY MARTIN MILLS M D A MEDICAL CORPORATION
Other - Org Name:ANTONY MARTIN MILLS MD A MEDICAL CORPORATION 8601
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:MILLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-550-1010
Mailing Address - Street 1:8601 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90003-3319
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8601 S BROADWAY
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90003-3319
Practice Address - Country:US
Practice Address - Phone:323-905-5675
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANTHONY MARTIN MILLS MD A MEDICAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-08-13
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty