Provider Demographics
NPI:1982917654
Name:SM MED CORP, APC
Entity Type:Organization
Organization Name:SM MED CORP, APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROCHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-465-6614
Mailing Address - Street 1:PO BOX 260920
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91426-0920
Mailing Address - Country:US
Mailing Address - Phone:818-465-6614
Mailing Address - Fax:
Practice Address - Street 1:5000 VAN NUYS BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-1793
Practice Address - Country:US
Practice Address - Phone:818-465-6614
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-22
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA75531207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty