Basic Information
| Provider Information | |||||||||
| NPI: | 1558394361 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | USC UNIVERSITY HOSPITAL, INC. | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| OtherOrganizationName: | USC HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | FILE 57489 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900747489 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6263004122 | ||||||||
| FaxNumber: | 3234428672 | ||||||||
| Practice Location | |||||||||
| Address1: | 1500 SAN PABLO ST | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900335313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3234428500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2006 | ||||||||
| LastUpdateDate: | 05/26/2016 | ||||||||
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| AuthorizedOfficialLastName: | ARMIN | ||||||||
| AuthorizedOfficialFirstName: | CRAIG | ||||||||
| AuthorizedOfficialMiddleName: | C. | ||||||||
| AuthorizedOfficialTitleorPosition: | VP OF GOVT PROGRAMS, TENET | ||||||||
| AuthorizedOfficialTelephone: | 3107758043 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 930000459 | CA | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 000439 | 01 | HUMANA | OTHER | USCU | 01 | UNIVERSAL CARE | OTHER | HSC30696G | 05 | CA | MEDICAID | HSP40696G | 05 | CA | MEDICAID | 8487 | 01 | HEALTH NET | OTHER | 181704000 | 01 | DEPT OF LABOR | OTHER | 006376-0001 | 01 | PACIFICARE OF CALIFORNIA | OTHER | 050696 | 01 | KAISER | OTHER | HSM30696G | 05 | CA | MEDICAID | ZZZA1905A | 01 | BS OF CALIFORNIA | OTHER | 050696 | 01 | BLUE CROSS | OTHER | 050696B000000 | 01 | SECTION 1011 | OTHER | 438535950 | 01 | AETNA US HEALTHCARE | OTHER |