Provider Demographics
NPI:1912398660
Name:GS MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:GS MEDICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD, QME
Authorized Official - Phone:310-320-1970
Mailing Address - Street 1:PO BOX 4116
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-1746
Mailing Address - Country:US
Mailing Address - Phone:310-320-1970
Mailing Address - Fax:888-988-8315
Practice Address - Street 1:2421 W 205TH ST
Practice Address - Street 2:STE D-107
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-1468
Practice Address - Country:US
Practice Address - Phone:310-320-1970
Practice Address - Fax:888-988-8315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-16
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50680261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain