Provider Demographics
NPI:1982650271
Name:SOUTH BAY EMERGENCY MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:SOUTH BAY EMERGENCY MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-379-2134
Mailing Address - Street 1:111 N SEPULVEDA BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-6861
Mailing Address - Country:US
Mailing Address - Phone:310-379-2134
Mailing Address - Fax:310-379-4856
Practice Address - Street 1:2740 M ST
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-2813
Practice Address - Country:US
Practice Address - Phone:209-384-6480
Practice Address - Fax:209-384-6710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0068932Medicaid
CAGR0068932Medicaid