Provider Demographics
NPI: | 1932731627 |
---|---|
Name: | URGENT ORTHOPEDIC |
Entity Type: | Organization |
Organization Name: | URGENT ORTHOPEDIC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | TIGRAN |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | AVOIAN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 818-638-3348 |
Mailing Address - Street 1: | 6651 ELMHURST DR |
Mailing Address - Street 2: | |
Mailing Address - City: | TUJUNGA |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 91042-3353 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 818-638-3348 |
Mailing Address - Fax: | 818-637-2250 |
Practice Address - Street 1: | 1511 W GLENOAKS BLVD |
Practice Address - Street 2: | |
Practice Address - City: | GLENDALE |
Practice Address - State: | CA |
Practice Address - Zip Code: | 91201-1912 |
Practice Address - Country: | US |
Practice Address - Phone: | 818-638-3348 |
Practice Address - Fax: | 818-637-2250 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2020-02-10 |
Last Update Date: | 2020-02-10 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 261QU0200X | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care | |
No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Single Specialty |