Basic Information
| Provider Information | |||||||||
| NPI: | 1811137557 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THOMAS L. HEDGE, M.D. A MEDICAL CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8300 | ||||||||
| Address2: | |||||||||
| City: | NORTHRIDGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913278300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6616181771 | ||||||||
| FaxNumber: | 6612879471 | ||||||||
| Practice Location | |||||||||
| Address1: | 18300 ROSCOE BLVD 4IFL TOWER | ||||||||
| Address2: | |||||||||
| City: | NORTHRIDGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913254167 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188855342 | ||||||||
| FaxNumber: | 8187271451 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2009 | ||||||||
| LastUpdateDate: | 02/20/2009 | ||||||||
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| AuthorizedOfficialLastName: | JOHNSON | ||||||||
| AuthorizedOfficialFirstName: | SHIRLEY | ||||||||
| AuthorizedOfficialMiddleName: | VIOLA | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 6616181771 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2081P0004X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Spinal Cord Injury Medicine |
No ID Information.