Provider Demographics
NPI:1093968414
Name:GED MEDICAL GROUP INC
Entity Type:Organization
Organization Name:GED MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:D
Authorized Official - Last Name:DIDDIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-393-8081
Mailing Address - Street 1:14545 FRIAR ST
Mailing Address - Street 2:SUITE 112
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-2397
Mailing Address - Country:US
Mailing Address - Phone:310-393-8081
Mailing Address - Fax:
Practice Address - Street 1:14545 FRIAR ST
Practice Address - Street 2:SUITE 112
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-2397
Practice Address - Country:US
Practice Address - Phone:310-393-8081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-29
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA39483Medicare PIN