Provider Demographics
NPI:1205232428
Name:VIRGIL MEDICAL CENTER INC
Entity Type:Organization
Organization Name:VIRGIL MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANJANA
Authorized Official - Middle Name:S
Authorized Official - Last Name:SURA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-487-7086
Mailing Address - Street 1:240 N VIRGIL AVE
Mailing Address - Street 2:UNIT 6
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-5399
Mailing Address - Country:US
Mailing Address - Phone:213-487-7086
Mailing Address - Fax:213-487-7089
Practice Address - Street 1:240 N VIRGIL AVE
Practice Address - Street 2:UNIT 6
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-5399
Practice Address - Country:US
Practice Address - Phone:213-487-7089
Practice Address - Fax:213-487-7089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-16
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty