Provider Demographics
NPI:1811137557
Name:THOMAS L. HEDGE, M.D. A MEDICAL CORPORATION
Entity type:Organization
Organization Name:THOMAS L. HEDGE, M.D. A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:VIOLA
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-618-1771
Mailing Address - Street 1:PO BOX 8300
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91327-8300
Mailing Address - Country:US
Mailing Address - Phone:661-618-1771
Mailing Address - Fax:661-287-9471
Practice Address - Street 1:18300 ROSCOE BLVD 4IFL TOWER
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-4167
Practice Address - Country:US
Practice Address - Phone:818-885-5342
Practice Address - Fax:818-727-1451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-20
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P0004XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSpinal Cord Injury MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA91655Medicare UPIN