| Advanced Community Medical Care Corp | |
|
323 N Prairie Ave Suite 417 Inglewood CA 90301-4502 | |
| (310) 680-1810 | |
| Not Available |
| Full Name | Advanced Community Medical Care Corp |
|---|---|
| Speciality | Clinic/Center |
| Location | 323 N Prairie Ave, Inglewood, California |
| Authorized Official Name and Position | Randall Whitaker Maxey (PRESIDENT) |
| Authorized Official Contact | 3106801810 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Advanced Community Medical Care Corp 447 N Prairie Ave Inglewood CA 90301-4502 Ph: (310) 680-1810 | Advanced Community Medical Care Corp 323 N Prairie Ave Suite 417 Inglewood CA 90301-4502 Ph: (310) 680-1810 |
| NPI Number | 1962851808 |
|---|---|
| Provider Enumeration Date | 06/10/2016 |
| Last Update Date | 10/02/2019 |
| Medicare PECOS PAC ID | 8224316120 |
|---|---|
| Medicare Enrollment ID | O20161027001925 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962851808 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Randall W Maxey |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1700944279 PECOS PAC ID: 3375647498 Enrollment ID: I20081215000265 |
| Provider Name | Mesfin Seyoum |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1780807008 PECOS PAC ID: 3779898283 Enrollment ID: I20150812008983 |
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