Provider Demographics
NPI:1912916214
Name:LANDMARK IMAGING SURGICAL CENTER, LLC
Entity Type:Organization
Organization Name:LANDMARK IMAGING SURGICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:SILVERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-914-7336
Mailing Address - Street 1:PO BOX 6809
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92863-6809
Mailing Address - Country:US
Mailing Address - Phone:888-598-8820
Mailing Address - Fax:714-571-5055
Practice Address - Street 1:11620 WILSHIRE BLVD
Practice Address - Street 2:STE. 102
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-1706
Practice Address - Country:US
Practice Address - Phone:310-914-7336
Practice Address - Fax:310-914-1826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00609867OtherRAILROAD MEDICARE
P00609867OtherRAILROAD MEDICARE