Provider Demographics
NPI:1174223044
Name:AHMC SETON MEDICAL CENTER LLC
Entity type:Organization
Organization Name:AHMC SETON MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SEVP
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-457-7488
Mailing Address - Street 1:55 S RAYMOND AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-7101
Mailing Address - Country:US
Mailing Address - Phone:650-991-6088
Mailing Address - Fax:
Practice Address - Street 1:1900 SULLIVAN AVE.
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2200
Practice Address - Country:US
Practice Address - Phone:650-991-6488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AHMC SETON MEDICAL CENTER LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZR00289GMedicaid