Basic Information
| Provider Information | |||||||||
| NPI: | 1912957598 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ORTHO URGENT CARE MEDICAL GROUP, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1700 EAST WALNUT AVENUE | ||||||||
| Address2: | #250 | ||||||||
| City: | EL SAGUNDO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902452605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103012030 | ||||||||
| FaxNumber: | 3103065247 | ||||||||
| Practice Location | |||||||||
| Address1: | 2400 S FLOWER ST | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900072629 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2137421013 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2006 | ||||||||
| LastUpdateDate: | 11/12/2008 | ||||||||
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| AuthorizedOfficialLastName: | STAUM | ||||||||
| AuthorizedOfficialFirstName: | BARRY | ||||||||
| AuthorizedOfficialMiddleName: | B. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT &CEO | ||||||||
| AuthorizedOfficialTelephone: | 3103012030 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | G28196 | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.