Healthcare Provider Details

I. General information

NPI: 1467476002
Provider Name (Legal Business Name): MEMORIAL PROMPT CARE MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 09/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9122 ADAMS AVE
HUNTINGTON BEACH CA
92646-3405
US

IV. Provider business mailing address

9122 ADAMS AVE
HUNTINGTON BEACH CA
92646-3405
US

V. Phone/Fax

Practice location:
  • Phone: 714-962-1780
  • Fax: 714-962-5128
Mailing address:
  • Phone: 714-962-1780
  • Fax: 714-962-5128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMIE BARTON LEWIS
Title or Position: EXECUTIVE DIRECTOR
Credential: M.D.
Phone: 714-891-9008