Provider Demographics
NPI:1346389905
Name:LOS ANGELES DOCTORS CORP
Entity Type:Organization
Organization Name:LOS ANGELES DOCTORS CORP
Other - Org Name:LOS ANGELES METROPOLITAN MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP/HOSPITAL CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-377-6842
Mailing Address - Street 1:2231 SOUTH WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90018-9903
Mailing Address - Country:US
Mailing Address - Phone:323-730-7300
Mailing Address - Fax:949-732-4671
Practice Address - Street 1:2231 SOUTH WESTERN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90018-9903
Practice Address - Country:US
Practice Address - Phone:323-730-7300
Practice Address - Fax:949-732-4671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA930000187273R00000X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05S644Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
CA1639195175Medicare NSC
CA1346389905Medicare NSC