Provider Demographics
NPI:1043824212
Name:MIDTOWN MEDICAL CORPORATION
Entity type:Organization
Organization Name:MIDTOWN MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIGEMATSU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-941-7309
Mailing Address - Street 1:17215 STUDEBAKER RD STE 320
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-2522
Mailing Address - Country:US
Mailing Address - Phone:760-941-7309
Mailing Address - Fax:
Practice Address - Street 1:1267 N VIRGIL AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-2017
Practice Address - Country:US
Practice Address - Phone:323-664-7628
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization