Provider Demographics
NPI:1427181577
Name:UNIVERSITY OF SOUTHERN CALIFORNIA
Entity Type:Organization
Organization Name:UNIVERSITY OF SOUTHERN CALIFORNIA
Other - Org Name:USC ELECTRON MICROSCOPY LABORATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR VP ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:DICKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-740-8184
Mailing Address - Street 1:PO BOX 513199
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033
Mailing Address - Country:US
Mailing Address - Phone:323-226-6507
Mailing Address - Fax:323-226-7069
Practice Address - Street 1:1200 NORTH STATE STREET
Practice Address - Street 2:BARRACKS D,
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033
Practice Address - Country:US
Practice Address - Phone:323-226-6507
Practice Address - Fax:323-226-7069
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF SOUTHERN CALIFORNIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-14
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA05D0714357291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACLF310871OtherSTATE
CALAB14357FMedicaid
CA05D0714357OtherCLIA
CA690000015OtherMEDICARE RAILROAD
CA05D0714357Medicare PIN