Provider Demographics
NPI:1528472636
Name:AMERICAN HEALTH MEDICAL GROUP
Entity type:Organization
Organization Name:AMERICAN HEALTH MEDICAL GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:BROSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-645-1100
Mailing Address - Street 1:1900 OFARRELL ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-1386
Mailing Address - Country:US
Mailing Address - Phone:650-645-1100
Mailing Address - Fax:650-645-1197
Practice Address - Street 1:1900 OFARRELL ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-1386
Practice Address - Country:US
Practice Address - Phone:650-645-1100
Practice Address - Fax:650-645-1197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-17
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG55824174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty