Provider Demographics
NPI:1366491920
Name:ORTHOPEDIC SURGERY MEDICAL GROUP
Entity Type:Organization
Organization Name:ORTHOPEDIC SURGERY MEDICAL GROUP
Other - Org Name:BEVERLY HILLS ORTHOPEDIC GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:DONOHUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-659-2910
Mailing Address - Street 1:BEVERLY HILLS ORTHOPEDIC GROUP
Mailing Address - Street 2:DEPT. LA 23656
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91185-3656
Mailing Address - Country:US
Mailing Address - Phone:310-659-2910
Mailing Address - Fax:310-652-2568
Practice Address - Street 1:120 S SPALDING DR
Practice Address - Street 2:SUITE 401
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-1800
Practice Address - Country:US
Practice Address - Phone:310-659-2910
Practice Address - Fax:310-652-2568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW11785Medicare PIN
CA0827950001Medicare NSC