# OMNICARE MEDICAL GROUP, INC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** OMNICARE MEDICAL GROUP, INC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1457548604
- **Legal business name:** OMNICARE MEDICAL GROUP, INC
- **Authorized official:** TONI JOHNSON-CHAVIS MD (CHIEF EXECUTIVE OFFICER)
- **Authorized official phone:** (310) 605-0000

## Contact information

- **Practice address:** 3680 E IMPERIAL HWY, SUITE 480, LYNWOOD, CA 90262-2659
- **Practice address phone:** (310) 605-0000
- **Practice address fax:** (310) 605-0051
- **Mailing address:** 3680 E IMPERIAL HWY, SUITE 480, LYNWOOD, CA 90262-2659
- **Mailing address phone:** (310) 605-0000
- **Mailing address fax:** (310) 605-0051

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302R00000X | Health Maintenance Organization | — | NULL | Yes |

## Other

- **Enumeration date:** 10/02/2007
- **Last updated:** 10/02/2007