Provider Demographics
NPI:1841348216
Name:PROFESSIONAL HEALTH MEDIA SERVICES, INC
Entity type:Organization
Organization Name:PROFESSIONAL HEALTH MEDIA SERVICES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:F
Authorized Official - Last Name:GOOGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-796-6996
Mailing Address - Street 1:PO BOX 922
Mailing Address - Street 2:25244 REDLANDS BLVD
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-0922
Mailing Address - Country:US
Mailing Address - Phone:909-796-6996
Mailing Address - Fax:909-799-6620
Practice Address - Street 1:25244 REDLANDS BLVD
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-1924
Practice Address - Country:US
Practice Address - Phone:909-796-6996
Practice Address - Fax:909-799-6620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME00159FMedicaid
CADME00159FMedicaid