Provider Demographics
NPI:1184731960
Name:PORTER RANCH MEDICAL CENTER
Entity type:Organization
Organization Name:PORTER RANCH MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KEH
Authorized Official - Suffix:
Authorized Official - Credentials:DAOM
Authorized Official - Phone:818-831-8000
Mailing Address - Street 1:11177 TAMPA AVENUE
Mailing Address - Street 2:SUITE A
Mailing Address - City:PORTER RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91326-2254
Mailing Address - Country:US
Mailing Address - Phone:818-831-8000
Mailing Address - Fax:818-831-8005
Practice Address - Street 1:11177 TAMPA AVENUE
Practice Address - Street 2:SUITE A
Practice Address - City:PORTER RANCH
Practice Address - State:CA
Practice Address - Zip Code:91326-2254
Practice Address - Country:US
Practice Address - Phone:818-831-8000
Practice Address - Fax:818-831-8005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA22208171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Multi-Specialty