Healthcare Provider Details

I. General information

NPI: 1144792011
Provider Name (Legal Business Name): CCHP EMS CA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2018
Last Update Date: 12/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1081 N CHINA LAKE BLVD
RIDGECREST CA
93555-3130
US

IV. Provider business mailing address

700 CENTRAL EXPY S STE 400
ALLEN TX
75013-8113
US

V. Phone/Fax

Practice location:
  • Phone: 760-446-3551
  • Fax: 818-462-0991
Mailing address:
  • Phone: 866-225-0350
  • Fax: 818-462-0991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LAWRENCE A BEAN
Title or Position: PRESIDENT, MANAGING PARTNER
Credential: MD
Phone: 866-225-0350