Provider Demographics
NPI:1578866760
Name:MOTION PICTURE AND TELEVISION FUND MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:MOTION PICTURE AND TELEVISION FUND MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/COE
Authorized Official - Prefix:MR
Authorized Official - First Name:BOB
Authorized Official - Middle Name:
Authorized Official - Last Name:BEITCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-876-1371
Mailing Address - Street 1:23388 MULHOLLAND DR
Mailing Address - Street 2:MAILSTOP 62
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-2733
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1000 FLOWER ST
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91201-3007
Practice Address - Country:US
Practice Address - Phone:818-295-3369
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-10
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty