Basic Information
| Provider Information | |||||||||
| NPI: | 1184655581 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LAKEWOOD REGIONAL MEDICAL CENTER, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | LAKEWOOD REGIONAL MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | FILE 57508 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900740001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6263004122 | ||||||||
| FaxNumber: | 5626020083 | ||||||||
| Practice Location | |||||||||
| Address1: | 3700 SOUTH ST | ||||||||
| Address2: | |||||||||
| City: | LAKEWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907121419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5625312550 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2006 | ||||||||
| LastUpdateDate: | 03/23/2022 | ||||||||
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| AuthorizedOfficialLastName: | KILLION | ||||||||
| AuthorizedOfficialFirstName: | SCOTT | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 5622726420 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 930000046 | CA | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 050581B000000 | 01 | SECTION 1011 | OTHER | HSC30581G | 05 | CA | MEDICAID | 272609 | 01 | COVENTRY HEALTH CARE KANS | OTHER | HSP40581G | 05 | CA | MEDICAID | 000405 | 01 | HUMANA | OTHER | 017523-0001 | 01 | PACIFICARE OF CALIFORNIA | OTHER | 8091 | 01 | HEALTH NET | OTHER | ZZZA1971Z | 01 | BS OF CALIFORNIA | OTHER | 684778260 | 01 | AETNA US HEALTHCARE | OTHER |