Provider Demographics
NPI:1750428264
Name:GLENMOUNTAIN MEDICAL GROUP INC
Entity type:Organization
Organization Name:GLENMOUNTAIN MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:ELSHIRE SR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-268-1785
Mailing Address - Street 1:417 W FOOTHILL BLVD STE B
Mailing Address - Street 2:# 482
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741-5301
Mailing Address - Country:US
Mailing Address - Phone:323-268-1785
Mailing Address - Fax:
Practice Address - Street 1:3467 WHITTIER BLVD
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90023-1707
Practice Address - Country:US
Practice Address - Phone:323-268-1785
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty