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Organization
OMNICARE MEDICAL GROUP, INC
Active
Organization
OMNICARE MEDICAL GROUP, INC
Active
Parent organization
OMNICARE MEDICAL GROUP, INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
OMNICARE MEDICAL GROUP, INC
Authorized official
TONI JOHNSON-CHAVIS MD (CHIEF EXECUTIVE OFFICER)
(310) 605-0000
Entity
Organization
Contact information
Practice address
3680 E IMPERIAL HWY, SUITE 480, LYNWOOD, CA 90262-2659
(310) 605-0000
(310) 605-0051
Mailing address
3680 E IMPERIAL HWY, SUITE 480, LYNWOOD, CA 90262-2659
(310) 605-0000
(310) 605-0051
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
—
NULL
Other
Enumeration date
10/02/2007
Last updated
10/02/2007
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