Provider Demographics
NPI:1952546616
Name:UNIVERSITY OF SOUTHERN CALIFORNIA
Entity Type:Organization
Organization Name:UNIVERSITY OF SOUTHERN CALIFORNIA
Other - Org Name:KECK HOSPITAL OF USC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP & CEO, KECK MEDICINE OF USC
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:JACKIEWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-442-9775
Mailing Address - Street 1:1500 SAN PABLO ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-9857
Mailing Address - Country:US
Mailing Address - Phone:323-442-8444
Mailing Address - Fax:323-442-5257
Practice Address - Street 1:1500 SAN PABLO STREET
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-9857
Practice Address - Country:US
Practice Address - Phone:323-442-8500
Practice Address - Fax:323-442-8727
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF SOUTHERN CALIFOR
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-10
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA930000459282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHSC30696GMedicaid
CAHSP40696GMedicaid
CA050696Medicare PIN
CAHSP40696GMedicaid