Provider Demographics
NPI:1407868417
Name:INGLEWOOD IMAGING CENTER LLC
Entity Type:Organization
Organization Name:INGLEWOOD IMAGING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-672-9729
Mailing Address - Street 1:211 N PRAIRIE AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-1412
Mailing Address - Country:US
Mailing Address - Phone:310-672-9729
Mailing Address - Fax:310-672-9720
Practice Address - Street 1:211 N PRAIRIE AVE
Practice Address - Street 2:SUITE E
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-1412
Practice Address - Country:US
Practice Address - Phone:310-672-9729
Practice Address - Fax:310-672-9720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAIDTF00760Medicaid
CAIDTF00760Medicaid