Provider Demographics
NPI:1881641462
Name:SOUTHERN CALIFORNIA ACUTE CARE PHYSICIANS
Entity type:Organization
Organization Name:SOUTHERN CALIFORNIA ACUTE CARE PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:L
Authorized Official - Last Name:GLAVINOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-497-4225
Mailing Address - Street 1:PO BOX 4419
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91365-4419
Mailing Address - Country:US
Mailing Address - Phone:866-266-6980
Mailing Address - Fax:818-587-2493
Practice Address - Street 1:14662 NEWPORT AVE
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-6064
Practice Address - Country:US
Practice Address - Phone:714-669-2000
Practice Address - Fax:818-587-2493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR008930Medicaid
CAGR0089931Medicaid
CAZZZ03049ZOtherBLUE SHIELD
CADC9564OtherRAILROAD MEDICARE
CACH8363OtherRAILROAD MEDICARE
CAZZZ01338ZOtherBLUE SHIELD
CAZZZ01337ZOtherBLUE SHIELD
CAGR0089932Medicaid
CAZZZ01338ZOtherBLUE SHIELD
CAHW15284BMedicare ID - Type Unspecified
CAHW15284AMedicare ID - Type Unspecified