MEDICARE: PORTER RANCH MEDICAL CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171W00000X	Contractor	A22208	CA

General Provider Information

NPI Number	:	1184731960
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PORTER RANCH MEDICAL CENTER

Provider Business Mailing Address
First Line	:	11177 TAMPA AVENUE
Second Line	:	SUITE A
City	:	PORTER RANCH
State	:	CA
Zip	:	91326-2254
Country	:	US
Telephone Number	:	818-831-8000
Fax Number	:	818-831-8005

Provider Business Practice Location Address
First Line	:	11177 TAMPA AVENUE
Second Line	:	SUITE A
City	:	PORTER RANCH
State	:	CA
Zip	:	91326-2254
Country	:	US
Telephone Number	:	818-831-8000
Fax Number	:	818-831-8005

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GERIE KEH
Credential	:	D.A.O.M
Telephone Number	:	818-831-8000

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	03/23/2011

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Directions to “PORTER RANCH MEDICAL CENTER ” Practice Location

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