Provider Demographics
NPI:1871119982
Name:AMEN CLINICS INC, LA
Entity type:Organization
Organization Name:AMEN CLINICS INC, LA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DATA SYSTEMS SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:T
Authorized Official - Last Name:MCCORMICK
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:703-880-4000
Mailing Address - Street 1:5363 BALBOA BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-2802
Mailing Address - Country:US
Mailing Address - Phone:818-479-4400
Mailing Address - Fax:
Practice Address - Street 1:5363 BALBOA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-2802
Practice Address - Country:US
Practice Address - Phone:818-479-4400
Practice Address - Fax:818-305-3779
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMEN CLINICS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-06-24
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084D0003XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyDiagnostic NeuroimagingGroup - Multi-Specialty