Provider Demographics
NPI:1700836392
Name:ORTHOPEDIC MEDICAL CENTER, AN INC MEDICAL CLINIC
Entity Type:Organization
Organization Name:ORTHOPEDIC MEDICAL CENTER, AN INC MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-708-8100
Mailing Address - Street 1:18039 SHERMAN WAY
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-4630
Mailing Address - Country:US
Mailing Address - Phone:818-708-8100
Mailing Address - Fax:818-705-8818
Practice Address - Street 1:18039 SHERMAN WAY
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-4630
Practice Address - Country:US
Practice Address - Phone:818-708-8100
Practice Address - Fax:818-705-8818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW8424Medicare ID - Type Unspecified
CA0479020001Medicare NSC