1467658849 NPI number — UNIVERSITY OF SOUTHERN CALIFORNIA

Table of content: (NPI 1467658849)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467658849 NPI number — UNIVERSITY OF SOUTHERN CALIFORNIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY OF SOUTHERN CALIFORNIA
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:
Provider Other Organization Name Type Code:
6
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:
1467658849
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/30/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 31309
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:
90031-0309
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-442-1156
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2011 ZONAL AVE
Provider Second Line Business Practice Location Address:
HRM 308 AND 310
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90089-0110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-442-1156
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DICKEY
Authorized Official First Name:
TODD
Authorized Official Middle Name:
Authorized Official Title or Position:
SR VP ADMINISTRATION
Authorized Official Telephone Number:
213-740-8184

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: LAB33784F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 05D1033784 . This is a "CLIA NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: CLF332197 . This is a "STATE LIC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 690000015 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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