Provider Demographics
NPI:1386356178
Name:PRIMARY AND MULTI-SPECIALTY CLINICS OF ANAHEIM
Entity type:Organization
Organization Name:PRIMARY AND MULTI-SPECIALTY CLINICS OF ANAHEIM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:WAY
Authorized Official - Last Name:LEW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-813-5129
Mailing Address - Street 1:710 N EUCLID ST STE 400
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-4132
Mailing Address - Country:US
Mailing Address - Phone:714-517-2000
Mailing Address - Fax:714-490-1975
Practice Address - Street 1:3030 W BALL RD
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-3897
Practice Address - Country:US
Practice Address - Phone:657-337-5055
Practice Address - Fax:657-337-5057
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRIMARY AND MULTI-SPECIALTY CLINICS OF ANAHEIM, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-12-23
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0099850Medicaid