Provider Demographics
NPI:1427663368
Name:AMG IPA
Entity type:Organization
Organization Name:AMG IPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AJAY
Authorized Official - Middle Name:G
Authorized Official - Last Name:MEKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-750-2060
Mailing Address - Street 1:201 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-5633
Mailing Address - Country:US
Mailing Address - Phone:949-750-2060
Mailing Address - Fax:
Practice Address - Street 1:201 S BROADWAY
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-5633
Practice Address - Country:US
Practice Address - Phone:949-750-2060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization