Provider Demographics
NPI:1225188204
Name:ST.ANTHONY MEDICAL CENTERS
Entity Type:Organization
Organization Name:ST.ANTHONY MEDICAL CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:AWAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTHONY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-469-5555
Mailing Address - Street 1:6368 HOLLYWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90028-6320
Mailing Address - Country:US
Mailing Address - Phone:323-469-5555
Mailing Address - Fax:323-466-0405
Practice Address - Street 1:837 W IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90044-4110
Practice Address - Country:US
Practice Address - Phone:323-755-9555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC70866FMedicaid
CAHAP70866FOtherFAMILY PACT
CA05-1030Medicare ID - Type Unspecified