Provider Demographics
NPI:1700157641
Name:EMERGENCY PHYSICIANS INDUSTRIAL MEDICAL ASSOCIATES, INC.
Entity Type:Organization
Organization Name:EMERGENCY PHYSICIANS INDUSTRIAL MEDICAL ASSOCIATES, INC.
Other - Org Name:INDUSTRIAL MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-922-8282
Mailing Address - Street 1:3070 SKYWAY DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93455-1829
Mailing Address - Country:US
Mailing Address - Phone:805-922-8282
Mailing Address - Fax:
Practice Address - Street 1:3070 SKYWAY DR
Practice Address - Street 2:SUITE 106
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93455-1829
Practice Address - Country:US
Practice Address - Phone:805-922-8282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-24
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA67623OtherCALIFORNIA STATE MEDICAL BOARD