MEDICARE: AHC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	246RP1900X	Phlebotomy Technician
2	261QR0200X	Radiology Clinic/Center
3	2085U0001X	Diagnostic Ultrasound Physician

General Provider Information

NPI Number	:	1730729674
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AHC LLC

Provider Business Mailing Address
First Line	:	31959 10TH AVE STE B
Second Line	:
City	:	LAGUNA BEACH
State	:	CA
Zip	:	92651-6838
Country	:	US
Telephone Number	:	800-558-0312
Fax Number	:	949-281-7707

Provider Business Practice Location Address
First Line	:	1218 E ARABIAN LN
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99208-6735
Country	:	US
Telephone Number	:	949-466-9939
Fax Number	:	949-281-7707

Authorized Official
Title or Position	:	MEMBER
Name	:	MARTIN CANALES
Credential	:
Telephone Number	:	949-466-9939

Provider Enumeration Date	:	01/08/2020
Last Update Date	:	01/08/2020

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