Provider Demographics
NPI:1356398978
Name:SAN DIEGO MEDICAL SERVICES ENTERPRISE, LLC
Entity type:Organization
Organization Name:SAN DIEGO MEDICAL SERVICES ENTERPRISE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:A
Authorized Official - Last Name:BARTOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-606-3525
Mailing Address - Street 1:PO BOX 53518
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85072-3518
Mailing Address - Country:US
Mailing Address - Phone:480-606-3701
Mailing Address - Fax:480-606-3677
Practice Address - Street 1:10405 SAN DIEGO MISSION RD
Practice Address - Street 2:200
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-2102
Practice Address - Country:US
Practice Address - Phone:619-280-6060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMTE00934FMedicaid
CA590011868OtherRR MEDICARE
CAMTE00934FMedicaid