Provider Demographics
NPI:1699867804
Name:SHORR SMITH AND HURST MDS
Entity type:Organization
Organization Name:SHORR SMITH AND HURST MDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-673-4900
Mailing Address - Street 1:501 EAST HARDY STREET
Mailing Address - Street 2:SUITE 210
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-4504
Mailing Address - Country:US
Mailing Address - Phone:310-673-4900
Mailing Address - Fax:310-673-1319
Practice Address - Street 1:501 EAST HARDY STREET
Practice Address - Street 2:SUITE 210
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301
Practice Address - Country:US
Practice Address - Phone:310-673-4900
Practice Address - Fax:310-673-1319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0078930Medicaid
CAGR0078930Medicaid
CAX05247Medicare UPIN