Provider Demographics
NPI:1013969153
Name:EMERGENCY PHYSICIANS ASSOCIATES OVERHEAD OPERATING ACCOUNT DENNIS BELO
Entity Type:Organization
Organization Name:EMERGENCY PHYSICIANS ASSOCIATES OVERHEAD OPERATING ACCOUNT DENNIS BELO
Other - Org Name:EMERGENCY PHYSICIAN ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAMI
Authorized Official - Middle Name:A
Authorized Official - Last Name:JADALLAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-947-2500
Mailing Address - Street 1:PO BOX 4419
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91365-4419
Mailing Address - Country:US
Mailing Address - Phone:888-620-3100
Mailing Address - Fax:818-587-2493
Practice Address - Street 1:2105 FOREST AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-1425
Practice Address - Country:US
Practice Address - Phone:408-947-2500
Practice Address - Fax:818-587-2493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0017960Medicaid
CAGR0017960Medicaid