EBTKS MEDICAL CENTER, A PROF CORP. (NPI# 1073872610) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1073872610 |
Entity Type | Organization |
Organization Name | EBTKS MEDICAL CENTER, A PROF CORP. |
Other Organization Name | ADVANCED INJURY CENTER |
Practice Address |
4515 Hallmark Pkwy San Bernardino CA 92407-1834 |
Practice Telephone | 9096483551 |
Mailing Telephone | 9096483551 |
Enumeration Date | 2012-05-15 |
Last Update Date | 2018-04-30 |
Authorized Official Name | MICHAEL JOSEPH TRUDEAU (CEO) |
Authorized Official Telephone | 9096483551 |
Authorized Official Credential | DC |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 261QM1300X |
Clinic/Center Specialization: Multi-Specialty |
Ambulatory Health Care Facilities | ||
Y | 261QH0100X |
Clinic/Center Specialization: Health Service |
DC18676 | CA | Ambulatory Health Care Facilities |
Other Name | Type Code |
---|---|
Advanced Injury Center | Doing Business As Name - Organization |
Street Address |
4515 HALLMARK PKWY |
City | SAN BERNARDINO |
State | CA |
Zip Code | 92407-1834 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1689699233 | Michael Joseph Trudeau | Chiropractor | 4515 Hallmark Pkwy, San Bernardino, CA 92407-1834 | 2006-07-13 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1639789233 | Luis Enrique Macias | Case Manager/Care Coordinator | 26967 Beaumont Ave., Redlands Ca 92373, San Bernardino, CA 92407 | 2020-08-07 |
1619526209 | Louise E Curran | Social Worker | 6395 N Azalea Ave, San Bernardino, CA 92407 | 2019-09-06 |
1619496049 | Portia Monique Jackson | Licensed Vocational Nurse | 1022 Sunbrook Dr., San Bernardino, CA 92407 | 2017-09-18 |
1568988467 | Jon Michael Hensley | Behavior Technician | 1638 Windsor Street, San Bernardino, CA 92407 | 2017-08-22 |
1063933349 | Priority Rounds Transport, L.l.c | Non-emergency Medical Transport (VAN) | 18245 Evening Primrose Ln, San Bernardino, CA 92407 | 2017-06-27 |
1760927263 | Denkorach Inc | In Home Supportive Care | 1265 Kendall Drive, Unit 1614, San Bernardino, CA 92407 | 2016-12-20 |
1558606517 | Pradeep Amin | Pharmacist | 4150 N Sierra Way, San Bernardino, CA 92407 | 2012-12-03 |
1811231384 | Lucindy Thomasina Fuller | Rehabilitation Practitioner | 1265 Kendall Dr, San Bernardino, CA 92407 | 2012-11-21 |
1578793337 | Shareela Marie Allen | Social Worker | 6791 N. Ofeila Drive, San Bernardino, CA 92407 | 2009-07-15 |
1720239304 | Alejandro Paul Holguin | Social Worker | 6076 Norma Ln, San Bernardino, CA 92407 | 2008-10-01 |
Find all providers in zip 92407 |
Taxonomy Code | 261QH0100X |
Grouping | Ambulatory Health Care Facilities |
Classification | Clinic/Center |
Specialization | Health Service |
Definition to come... |
Notes: [7/1/2006: modified title] |
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1225273600 | Ayla Corporation | Clinic/Center | 164 W Hospitality Ln Ste 7, San Bernardino, CA 92408-3329 | 2008-12-12 |
1982246872 | Occupational Health Centers of California, A Medical Corporation | Clinic/Center | 1910 E Central Ave, San Bernardino, CA 92408-0123 | 2019-10-11 |
1851868012 | Occupational Health Centers of California, A Medical Corporation | Clinic/Center | 599 Inland Center Dr Ste 105, San Bernardino, CA 92408-1819 | 2018-10-25 |
1053438408 | H Street Medical Associates, Inc | Clinic/Center | 1329 N H St, San Bernardino, CA 92405-5039 | 2007-03-23 |
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Find all providers with the same taxonomy |
City | SAN BERNARDINO |
Zip Code | 92407 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.