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
—
—
Other
Enumeration date
10/02/2007
Last updated
10/02/2007
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