Provider Demographics
NPI:1952813941
Name:ARC ORTHOPEDIC GROUP
Entity Type:Organization
Organization Name:ARC ORTHOPEDIC GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GINGER
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-348-7253
Mailing Address - Street 1:7230 MEDICAL CENTER DR STE 500
Mailing Address - Street 2:
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-4024
Mailing Address - Country:US
Mailing Address - Phone:818-348-7253
Mailing Address - Fax:818-348-7012
Practice Address - Street 1:5525 ETIWANDA AVE STE 324
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-6133
Practice Address - Country:US
Practice Address - Phone:818-708-9090
Practice Address - Fax:818-708-3901
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARC ORTHOPEDIC GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-10-30
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty