MEDICARE: BEDFORD BONE DENSITY 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	261QR0200X	Radiology Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00009168	OTHER	CA	CITY LICENSE

General Provider Information

NPI Number	:	1568682789
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEDFORD BONE DENSITY CENTER, INC.

Provider Business Mailing Address
First Line	:	436 N BEDFORD DR STE 214
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90210-4312
Country	:	US
Telephone Number	:	310-271-6520
Fax Number	:	310-271-3793

Provider Business Practice Location Address
First Line	:	436 N BEDFORD DR STE 214
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90210-4312
Country	:	US
Telephone Number	:	310-271-6520
Fax Number	:	310-271-3793

Authorized Official
Title or Position	:	PRESIDENT
Name	:	STEVEN J. JACOBS
Credential	:	M.D.
Telephone Number	:	310-271-6520

Provider Enumeration Date	:	04/27/2007
Last Update Date	:	08/22/2020

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