Provider Demographics
NPI:1154876852
Name:GS MEDICAL CENTER INC
Entity type:Organization
Organization Name:GS MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:424-206-8336
Mailing Address - Street 1:2980 N BEVERLY GLEN CIR STE 100
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90077-1728
Mailing Address - Country:US
Mailing Address - Phone:310-474-9809
Mailing Address - Fax:800-337-6311
Practice Address - Street 1:715 S AVERILL AVE
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90732-3813
Practice Address - Country:US
Practice Address - Phone:424-206-8336
Practice Address - Fax:800-337-6311
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GS MEDICAL CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-23
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50680332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site