Provider Demographics
NPI:1558394361
Name:USC UNIVERSITY HOSPITAL, INC.
Entity Type:Organization
Organization Name:USC UNIVERSITY HOSPITAL, INC.
Other - Org Name:USC HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF GOVT PROGRAMS, TENET
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:C
Authorized Official - Last Name:ARMIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-775-8043
Mailing Address - Street 1:FILE 57489
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-7489
Mailing Address - Country:US
Mailing Address - Phone:626-300-4122
Mailing Address - Fax:323-442-8672
Practice Address - Street 1:1500 SAN PABLO ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-5313
Practice Address - Country:US
Practice Address - Phone:323-442-8500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA930000459282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
000439OtherHUMANA
USCUOtherUNIVERSAL CARE
CAHSC30696GMedicaid
CAHSP40696GMedicaid
8487OtherHEALTH NET
181704000OtherDEPT OF LABOR
006376-0001OtherPACIFICARE OF CALIFORNIA
050696OtherKAISER
CAHSM30696GMedicaid
ZZZA1905AOtherBS OF CALIFORNIA
050696OtherBLUE CROSS
050696B000000OtherSECTION 1011
438535950OtherAETNA US HEALTHCARE
=========900330002OtherTRICARE
CAHSC30696GMedicaid