| Southstate Medical Incorporated | |
|
1043 Civic Center Drive West Santa Ana CA 92703 | |
| (949) 401-2014 | |
| Not Available |
| Full Name | Southstate Medical Incorporated |
|---|---|
| Speciality | Clinic/Center |
| Location | 1043 Civic Center Drive West, Santa Ana, California |
| Authorized Official Name and Position | Amanda Aden (PRESIDENT) |
| Authorized Official Contact | 9494012014 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southstate Medical Incorporated 18685 Main St Ste 101 Huntington Beach CA 92648-1719 Ph: (949) 401-2014 | Southstate Medical Incorporated 1043 Civic Center Drive West Santa Ana CA 92703 Ph: (949) 401-2014 |
| NPI Number | 1760248900 |
|---|---|
| Provider Enumeration Date | 02/26/2024 |
| Last Update Date | 06/27/2024 |
| Medicare PECOS PAC ID | 0345782132 |
|---|---|
| Medicare Enrollment ID | O20240607002480 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760248900 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
| 261QU0200X | Clinic/center - Urgent Care | (* (Not Available)) | Primary |
| Provider Name | Ronald I Jacoby |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1346269669 PECOS PAC ID: 5193985737 Enrollment ID: I20150220000913 |
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