Provider Demographics
NPI:1245714351
Name:COLLECTIVE HEALTH GROUP INC
Entity type:Organization
Organization Name:COLLECTIVE HEALTH GROUP INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:KYLE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:818-745-7590
Mailing Address - Street 1:18607 VENTURA BLVD STE 302
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-4158
Mailing Address - Country:US
Mailing Address - Phone:818-745-7590
Mailing Address - Fax:818-938-9193
Practice Address - Street 1:18607 VENTURA BLVD STE 302
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-4158
Practice Address - Country:US
Practice Address - Phone:818-745-7590
Practice Address - Fax:818-938-9193
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLLECTIVE HEALTH GROUP INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-09-24
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty