Provider Demographics
NPI:1720471097
Name:INTERCEDE HEALTH OF CALIFORNIA
Entity Type:Organization
Organization Name:INTERCEDE HEALTH OF CALIFORNIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:MATHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-476-3900
Mailing Address - Street 1:2000 CRAWFORD ST
Mailing Address - Street 2:SUITE 1350
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77002-9000
Mailing Address - Country:US
Mailing Address - Phone:832-476-3900
Mailing Address - Fax:832-476-6494
Practice Address - Street 1:1680 E 120TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90059-3026
Practice Address - Country:US
Practice Address - Phone:832-476-3900
Practice Address - Fax:832-476-6494
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTERCEDE HEALTH, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-03-11
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080840401Medicaid
FL006694600Medicaid
FL006694600Medicaid
FLHG663AMedicare PIN
TX080840401Medicaid
VAC09087Medicare PIN