MEDICARE: LAUREL CANYON MEDICAL CENTER INC

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	261Q00000X	Clinic/Center	G47581	CA
2	261QM2500X	Medical Specialty Clinic/Center
3	174400000X	Specialist

General Provider Information

NPI Number	:	1407164221
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAUREL CANYON MEDICAL CENTER INC

Provider Business Mailing Address
First Line	:	8002 LAUREL CANYON BLVD
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91605-1427
Country	:	US
Telephone Number	:	818-768-5700
Fax Number	:	818-768-5710

Provider Business Practice Location Address
First Line	:	8002 LAUREL CANYON BLVD
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91605-1427
Country	:	US
Telephone Number	:	818-768-5700
Fax Number	:	818-768-5710

Authorized Official
Title or Position	:	PRESIDENT
Name	:	STANTON S KREMSKY
Credential	:	MD
Telephone Number	:	818-768-5700

Provider Enumeration Date	:	09/14/2010
Last Update Date	:	09/15/2010

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