1356956692 NPI number — GOOD NEIGHBOR CLINIC & URGENT CARE, A MEDICAL CORPORATION

Table of content: (NPI 1356956692)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356956692 NPI number — GOOD NEIGHBOR CLINIC & URGENT CARE, A MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GOOD NEIGHBOR CLINIC & URGENT CARE, A MEDICAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
GOOD NEIGHBOR URGENT CARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356956692
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/18/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4300 CRENSHAW BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90008-4902
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-298-1668
Provider Business Mailing Address Fax Number:
323-298-0458

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4300 CRENSHAW BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90008-4902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-298-1668
Provider Business Practice Location Address Fax Number:
323-298-0458
Provider Enumeration Date:
09/14/2020

Additional Information

Authorized Official

Authorized Official Last Name:
MCKILLOP
Authorized Official First Name:
HAZEL
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
323-298-1668

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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