Provider Demographics
NPI:1437219276
Name:MINEHART MEDICAL CORPORATION
Entity Type:Organization
Organization Name:MINEHART MEDICAL CORPORATION
Other - Org Name:ENCINO SURGICAL MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ISAAC
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MINEHART
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-784-3125
Mailing Address - Street 1:PO BOX 1464
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91077-1464
Mailing Address - Country:US
Mailing Address - Phone:818-784-3125
Mailing Address - Fax:818-784-3126
Practice Address - Street 1:16250 VENTURA BLVD STE 165
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2273
Practice Address - Country:US
Practice Address - Phone:818-784-3125
Practice Address - Fax:818-784-3126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS051685AMedicare ID - Type Unspecified