Provider Demographics
NPI:1568682789
Name:BEDFORD BONE DENSITY CENTER, INC.
Entity Type:Organization
Organization Name:BEDFORD BONE DENSITY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-271-6520
Mailing Address - Street 1:436 N BEDFORD DR STE 214
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4312
Mailing Address - Country:US
Mailing Address - Phone:310-271-6520
Mailing Address - Fax:310-271-3793
Practice Address - Street 1:436 N BEDFORD DR STE 214
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4312
Practice Address - Country:US
Practice Address - Phone:310-271-6520
Practice Address - Fax:310-271-3793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00009168OtherCITY LICENSE