Provider Demographics
NPI:1871551119
Name:COLUMBIA EMERGENCY MEDICAL GROUP INC
Entity type:Organization
Organization Name:COLUMBIA EMERGENCY MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:
Authorized Official - Last Name:MASSOUDIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-447-0296
Mailing Address - Street 1:PO BOX 920122
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75392-0122
Mailing Address - Country:US
Mailing Address - Phone:888-237-1803
Mailing Address - Fax:818-587-2493
Practice Address - Street 1:2801 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1737
Practice Address - Country:US
Practice Address - Phone:562-933-2000
Practice Address - Fax:818-587-2493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0067440Medicaid
CAHW14054Medicare ID - Type Unspecified