MEDICARE: WILCOX MEMORIAL 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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1790921153
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILCOX MEMORIAL MEDICAL CENTER INC.

Provider Business Mailing Address
First Line	:	3700 WILSHIRE BLVD
Second Line	:	SUITE 422 B
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-2901
Country	:	US
Telephone Number	:	213-382-4350
Fax Number	:	213-382-3854

Provider Business Practice Location Address
First Line	:	3700 WILSHIRE BLVD
Second Line	:	SUITE 422 B
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-2901
Country	:	US
Telephone Number	:	213-382-4350
Fax Number	:	213-382-3854

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	ESTHER EDEM
Credential	:
Telephone Number	:	310-256-6586

Provider Enumeration Date	:	01/06/2009
Last Update Date	:	01/06/2009

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