Provider Demographics
NPI:1689019515
Name:EDWARD H SIMS M D FACS INC
Entity Type:Organization
Organization Name:EDWARD H SIMS M D FACS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:H
Authorized Official - Last Name:SIMS
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:310-631-9073
Mailing Address - Street 1:3625 MARTIN LUTHER KING JR BLVD STE 9
Mailing Address - Street 2:
Mailing Address - City:LYNWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90262-3509
Mailing Address - Country:US
Mailing Address - Phone:310-631-9073
Mailing Address - Fax:310-631-6354
Practice Address - Street 1:3625 MARTIN LUTHER KING JR BLVD STE 9
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-3509
Practice Address - Country:US
Practice Address - Phone:310-631-9073
Practice Address - Fax:310-631-6354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-06
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00G255180174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty