Provider Demographics
NPI:1689632374
Name:ORTHOPAEDIC HOSPITAL
Entity Type:Organization
Organization Name:ORTHOPAEDIC HOSPITAL
Other - Org Name:ORTHOPAEDIC INSTITUTE FOR CHILDREN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO AND MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:SCADUTO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:213-742-1000
Mailing Address - Street 1:403 WEST ADAMS BLVD.
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90007-2664
Mailing Address - Country:US
Mailing Address - Phone:213-742-1104
Mailing Address - Fax:213-742-1435
Practice Address - Street 1:403 WEST ADAMS BLVD.
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90007
Practice Address - Country:US
Practice Address - Phone:213-742-1104
Practice Address - Fax:213-742-1435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550000083261QC1500X, 261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACMM71097FMedicaid
CA550000083OtherDHCS LICENSE
CACMM71097FMedicaid