Provider Demographics
NPI:1235141466
Name:UNIVERSITY OF SOUTHERN CALIFORNIA ORTHOPAEDIC SURGERY ASSOCIATES, INC
Entity Type:Organization
Organization Name:UNIVERSITY OF SOUTHERN CALIFORNIA ORTHOPAEDIC SURGERY ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMEN
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:PATZAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-442-5860
Mailing Address - Street 1:1520 SAN PABLO ST
Mailing Address - Street 2:#2000
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-5310
Mailing Address - Country:US
Mailing Address - Phone:323-442-5860
Mailing Address - Fax:323-442-6990
Practice Address - Street 1:1520 SAN PABLO ST
Practice Address - Street 2:#2000
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-5310
Practice Address - Country:US
Practice Address - Phone:323-442-5860
Practice Address - Fax:323-442-6990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0050770Medicaid
CAW11600Medicare ID - Type Unspecified