Provider Demographics
NPI:1407164221
Name:LAUREL CANYON MEDICAL CENTER INC
Entity Type:Organization
Organization Name:LAUREL CANYON MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STANTON
Authorized Official - Middle Name:S
Authorized Official - Last Name:KREMSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-768-5700
Mailing Address - Street 1:8002 LAUREL CANYON BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91605-1427
Mailing Address - Country:US
Mailing Address - Phone:818-768-5700
Mailing Address - Fax:818-768-5710
Practice Address - Street 1:8002 LAUREL CANYON BLVD
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91605-1427
Practice Address - Country:US
Practice Address - Phone:818-768-5700
Practice Address - Fax:818-768-5710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-14
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X, 261QM2500X
CAG47581261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG47581Medicare PIN