Organization Name: | CHAMPION MEDICAL GROUP, A MEDICAL CORPORATION |
NPI Number: | 1386935716 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | HERBERT MARSHAK (MEDICAL DIRECTOR) |
Mailing Address: | 1206 E 17th St Ste 106 Santa Ana |
State: | CA US |
Postal Code: | 927012641 |
Phone Number: | 7142108848 |
Fax Number: | |
NPI Enumeration Date: | 04/19/2011 |
NPI Last Update Date: | 10/05/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 332900000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Non-Pharmacy Dispensing Site |
Taxonomy Specialization: | |
Taxonomy Definition: | A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.) |