Provider Demographics
NPI:1336669456
Name:BEACH CITIES ORTHOPEDICS SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:BEACH CITIES ORTHOPEDICS SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-546-3461
Mailing Address - Street 1:400 S SEPULVEDA BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-6876
Mailing Address - Country:US
Mailing Address - Phone:310-683-8895
Mailing Address - Fax:310-546-6481
Practice Address - Street 1:400 S SEPULVEDA BLVD STE 110
Practice Address - Street 2:
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-6814
Practice Address - Country:US
Practice Address - Phone:310-546-3461
Practice Address - Fax:310-546-6481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-20
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty