Provider Demographics
NPI:1790962165
Name:USC CARE MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:USC CARE MEDICAL GROUP, INC.
Other - Org Name:USC PSYCHIATRIC URGENT CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRATERY AND TRESURER
Authorized Official - Prefix:MS
Authorized Official - First Name:MELODY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-457-4145
Mailing Address - Street 1:PO BOX 31309
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-0309
Mailing Address - Country:US
Mailing Address - Phone:626-457-5801
Mailing Address - Fax:626-457-5811
Practice Address - Street 1:1100 N STATE STREET
Practice Address - Street 2:A1D
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033
Practice Address - Country:US
Practice Address - Phone:323-442-6018
Practice Address - Fax:323-442-6001
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:USC CARE MEDICAL GROUP, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-28
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0100430Medicaid