Provider Demographics
NPI:1003311713
Name:GREEN CROSS MEDICAL SURGICAL INC
Entity Type:Organization
Organization Name:GREEN CROSS MEDICAL SURGICAL INC
Other - Org Name:PHILIP H. LEE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OA
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:R
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-314-6514
Mailing Address - Street 1:7136 HASKELL AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-4112
Mailing Address - Country:US
Mailing Address - Phone:818-908-4086
Mailing Address - Fax:
Practice Address - Street 1:7136 HASKELL AVE STE 205
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-4112
Practice Address - Country:US
Practice Address - Phone:818-908-4086
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-26
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1003311713OtherORGANIZATION