Provider Demographics
NPI:1740003714
Name:ANTHEM MEDICAL SPECIALISTS INC
Entity type:Organization
Organization Name:ANTHEM MEDICAL SPECIALISTS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLADYS
Authorized Official - Middle Name:
Authorized Official - Last Name:SMEDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-996-2508
Mailing Address - Street 1:7786 LEMON PEPPER AVE
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-3407
Mailing Address - Country:US
Mailing Address - Phone:909-996-2508
Mailing Address - Fax:
Practice Address - Street 1:1940 W ORANGEWOOD AVE.
Practice Address - Street 2:SUITE 110 #2
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-5042
Practice Address - Country:US
Practice Address - Phone:909-996-2508
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-06
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care