Basic Information
| Provider Information | |||||||||
| NPI: | 1790778488 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ANAHEIM GLOBAL MEDICAL CENTER, INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | WMC-A INC | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1301 N TUSTIN AVE | ||||||||
| Address2: | |||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927058619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7149533500 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1025 S ANAHEIM BLVD | ||||||||
| Address2: | |||||||||
| City: | ANAHEIM | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928055806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7145336220 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2005 | ||||||||
| LastUpdateDate: | 06/22/2016 | ||||||||
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| AuthorizedOfficialLastName: | COLLINS | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 7149533652 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 060000117 | CA | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | HSP40594J | 05 | CA | MEDICAID | HSC30594J | 05 | CA | MEDICAID | HSD30594J | 05 | CA | MEDICAID | HSP30594J | 05 | CA | MEDICAID |