Provider Demographics
NPI:1194028647
Name:GS MEDICAL CENTER INC
Entity Type:Organization
Organization Name:GS MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-798-3334
Mailing Address - Street 1:9601 S SEPULVEDA BLVD
Mailing Address - Street 2:STE B
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5203
Mailing Address - Country:US
Mailing Address - Phone:310-798-3334
Mailing Address - Fax:
Practice Address - Street 1:9601 S SEPULVEDA BLVD
Practice Address - Street 2:STE B
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-5203
Practice Address - Country:US
Practice Address - Phone:310-798-3334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GS MEDICAL CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-12-06
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty