Provider Demographics
NPI:1124051354
Name:LANDMARK IMAGING MEDICAL GROUP, INC.
Entity type:Organization
Organization Name:LANDMARK IMAGING MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:M
Authorized Official - Last Name:SILVERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-914-7336
Mailing Address - Street 1:PO BOX 5667
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92863-5667
Mailing Address - Country:US
Mailing Address - Phone:888-598-8820
Mailing Address - Fax:714-571-5055
Practice Address - Street 1:11620 WILSHIRE BLVD
Practice Address - Street 2:STE. 100
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-1706
Practice Address - Country:US
Practice Address - Phone:310-914-7336
Practice Address - Fax:310-914-7326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ02770ZOtherBLUE SHIELD OF CA
CAGR0091540Medicaid
CJ5919OtherRAILROAD MEDICARE
W15413Medicare PIN