Provider Demographics
NPI:1245336403
Name:MEDICAL CENTER FOR BONE AND JOINT DISORDERS
Entity type:Organization
Organization Name:MEDICAL CENTER FOR BONE AND JOINT DISORDERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-920-0876
Mailing Address - Street 1:400 N MOUNTAIN AVENUE
Mailing Address - Street 2:#310
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786
Mailing Address - Country:US
Mailing Address - Phone:909-920-0876
Mailing Address - Fax:
Practice Address - Street 1:400 N. MOUNTAIN AVENUE #310
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786
Practice Address - Country:US
Practice Address - Phone:909-920-0876
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ61119ZOtherBLUE CROSS/BLUE SHIELD INSURANCE ID
CAZZZ17919ZMedicare PIN
CAZZZ61119ZOtherBLUE CROSS/BLUE SHIELD INSURANCE ID