Basic Information
| Provider Information | |||||||||
| NPI: | 1144792011 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CCHP EMS CA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 CENTRAL EXPY S STE 400 | ||||||||
| Address2: | |||||||||
| City: | ALLEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750138113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8662250350 | ||||||||
| FaxNumber: | 8184620991 | ||||||||
| Practice Location | |||||||||
| Address1: | 1081 N CHINA LAKE BLVD | ||||||||
| Address2: | |||||||||
| City: | RIDGECREST | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935553130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7604463551 | ||||||||
| FaxNumber: | 8184620991 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/17/2018 | ||||||||
| LastUpdateDate: | 12/17/2018 | ||||||||
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| AuthorizedOfficialLastName: | BEAN | ||||||||
| AuthorizedOfficialFirstName: | LAWRENCE | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT, MANAGING PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 8662250350 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | LAWRENCE A BEAN MD CCHP EMS CA INC | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.