Basic Information
| Provider Information | |||||||||
| NPI: | 1184820987 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | APEX HEALTHCARE MEDICAL CENTER INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 41889 E FLORIDA AVE | ||||||||
| Address2: | STATE HIGHWAY 74 | ||||||||
| City: | HEMET | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925445042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9516528700 | ||||||||
| FaxNumber: | 9517669944 | ||||||||
| Practice Location | |||||||||
| Address1: | 41889 E. FLORIDA AVE | ||||||||
| Address2: | 41889 STATE HIGHWAY 74 | ||||||||
| City: | HEMET | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925445042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9516528700 | ||||||||
| FaxNumber: | 9517669944 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2007 | ||||||||
| LastUpdateDate: | 12/05/2012 | ||||||||
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| AuthorizedOfficialLastName: | GUTIERREZ | ||||||||
| AuthorizedOfficialFirstName: | ROSE | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9516528700 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | APEX HEALTHCARE MEDICAL CENTER INC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | DA8292 | 01 | CA | MEDICARE RAILROAD | OTHER |