Provider Demographics
NPI:1982822052
Name:NEW HEALTHY VENTURE MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:NEW HEALTHY VENTURE MEDICAL GROUP, INC
Other - Org Name:INGLEWOOD URGENT CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:LEMAILE WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-481-1241
Mailing Address - Street 1:1711 W TEMPLE ST
Mailing Address - Street 2:SUITE7200
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-5421
Mailing Address - Country:US
Mailing Address - Phone:213-481-1241
Mailing Address - Fax:
Practice Address - Street 1:1711 W TEMPLE ST
Practice Address - Street 2:SUITE7200
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-5421
Practice Address - Country:US
Practice Address - Phone:310-348-0500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA29921207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC35367Medicare UPIN