NPIMap

Organization Active NPI

Antelope Valley Health Care District

  • Home Infusion Therapy Pharmacy
  • Lancaster, CA
National Provider Identifier
1194433938
Registry record updated Aug 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Infusion Therapy PharmacyTaxonomy code 3336H0001X
Legal business name
ANTELOPE VALLEY HEALTH CARE DISTRICT
Practice address
1600 W Avenue J
Infusion Pharmacy
Lancaster, CA 93534
Phone
(661) 949-5000
NPI assigned
Nov 10, 2022
Organization subpart
Yes
Parent organization
ANTELOPE VALLEY HEALTH CARE DISTRICTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 7, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Edward Mirzabegian
Title
Chief Executive Officer
Phone
(661) 949-5512

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Parenteral & Enteral Nutrition Supplies (DME) 332BP3500X
Community/Retail Pharmacy 3336C0003X
Home Infusion Therapy Pharmacy 3336H0001X Primary
Specialty Pharmacy 3336S0011X

Addresses

Primary practice location

1600 W Avenue J
Infusion Pharmacy
Lancaster, CA 93534

Mailing address

1600 W Avenue J
Infusion Pharmacy
Lancaster, CA 93534
Phone (661) 949-5000

Other names 1

  • Antelope Valley Medical Center Infusion Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230824004004 CA DME Supplier - Pharmacy 7618886532 Practice locations: Lancaster, CA

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D0587924Antelope Valley Medical Center1600 W Avenue J, Lancaster, CA 93534AccreditationFeb 27, 2027

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Antelope Valley Med Ctr Infusion1600 W Avenue J, Lancaster, CA 93534-2814(661) 949-5000 Immunosuppressive Drugs|Infusion Drugs|External Infusion Pumps and/or Supplies|Enteral Nutrients|Enteral Equipment and/or Supplies|Parenteral Nutrients|Parenteral Equipment and/or Supplies Accepts assignmentParticipating since Jun 21, 2023

National Provider Directory

National Provider Directory
Tax ID family
Antelope Valley Hosp-ER5 organizations share this tax ID, including this one
Part of
Antelope Valley Hosp-ER

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Antelope Valley HospitalLancaster, CA, CCN 050056 Hospital Operational/Managerial Control (100%) Jan 1, 1966

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1668038400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1691366400000",
    "number": "1194433938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 W AVENUE J",
            "address_2": "INFUSION PHARMACY",
            "city": "LANCASTER",
            "state": "CA",
            "postal_code": "93534",
            "telephone_number": "661-949-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 W AVENUE J",
            "address_2": "INFUSION PHARMACY",
            "city": "LANCASTER",
            "state": "CA",
            "postal_code": "93534",
            "telephone_number": "661-949-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANTELOPE VALLEY HEALTH CARE DISTRICT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ANTELOPE VALLEY HEALTH CARE DISTRICT",
        "enumeration_date": "2022-11-10",
        "last_updated": "2023-08-07",
        "certification_date": "2023-08-07",
        "status": "A",
        "authorized_official_last_name": "MIRZABEGIAN",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "661-949-5512",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332BP3500X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336H0001X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Home Infusion Therapy Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Antelope Valley Medical Center Infusion",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Antelope Valley Medical Center Infusion",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lancaster, CA

Sources for this page

Verify at the official NPI Registry.