Organization Name: | PRIMARY CRITICAL CARE MEDICAL GROUP |
NPI Number: | 1184823114 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | BRUCE T GIPE (PRESIDENT) |
Mailing Address: | 501 S Buena Vista St Burbank |
State: | CA US |
Postal Code: | 915054809 |
Phone Number: | 8188435111 |
Fax Number: | 8188430641 |
NPI Enumeration Date: | 07/11/2007 |
NPI Last Update Date: | 02/28/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | G42382 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |