Provider Demographics
NPI:1740227123
Name:USCAN ANESTHESIOLOGY MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:USCAN ANESTHESIOLOGY MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:D
Authorized Official - Last Name:LUMB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-442-7400
Mailing Address - Street 1:1520 SAN PABLO ST
Mailing Address - Street 2:SUITE 3451
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-5310
Mailing Address - Country:US
Mailing Address - Phone:323-442-7400
Mailing Address - Fax:323-442-7411
Practice Address - Street 1:1520 SAN PABLO ST
Practice Address - Street 2:SUITE 3451
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-5310
Practice Address - Country:US
Practice Address - Phone:323-442-7400
Practice Address - Fax:323-442-7411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Not Answered207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Not Answered207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care MedicineGroup - Multi-Specialty
Not Answered207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Not Answered2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
Not Answered367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ39324ZOtherBLUE SHIELD
CAGR0045960OtherCALOPTIMA
CAGR0045960Medicaid
CAGR0045960Medicaid
CAZZZ39324ZOtherBLUE SHIELD
CA=========OtherTRICARE