Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days.
Organization
1ST INDUSTRIAL MEDICAL GROUP
Active
Organization
1ST INDUSTRIAL MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK W BENNALLACK (CO OWNER)
(714) 289-4693
Entity
Organization
Contact information
Practice address
1234 W CHAPMAN AVE, SUITE 204, ORANGE, CA 92868-2862
(714) 289-4693
(714) 289-4698
Mailing address
1234 W CHAPMAN AVE, SUITE # 204, ORANGE, CA 92868-2862
(714) 289-4693
(714) 289-4698
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
—
—
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
—
207R00000X
Internal Medicine Physician
—
—
207XX0004X
Orthopaedic Foot and Ankle Surgery Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
—
2086S0122X
Plastic and Reconstructive Surgery Physician
—
—
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
—
—
213E00000X
Podiatrist
Primary
—
—
Other
Enumeration date
10/23/2007
Last updated
06/24/2008
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up