Provider Demographics
NPI:1346263399
Name:BELL HOSPITAL CORPORATION
Entity Type:Organization
Organization Name:BELL HOSPITAL CORPORATION
Other - Org Name:BELL HOSPITAL MEDICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:OKONKWO AGUOLU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-758-3600
Mailing Address - Street 1:1625 W VERNON AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90062-1612
Mailing Address - Country:US
Mailing Address - Phone:323-758-3600
Mailing Address - Fax:323-753-2446
Practice Address - Street 1:1625 W VERNON AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90062-1612
Practice Address - Country:US
Practice Address - Phone:323-758-3600
Practice Address - Fax:323-753-2446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA29427207Q00000X, 207R00000X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
W20638Medicare UPIN