MEDICARE: LANDMARK IMAGING SURGICAL CENTER, LLC

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

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00609867	OTHER		RAILROAD MEDICARE

General Provider Information

NPI Number	:	1912916214
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LANDMARK IMAGING SURGICAL CENTER, LLC

Provider Business Mailing Address
First Line	:	PO BOX 6809
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92863-6809
Country	:	US
Telephone Number	:	888-598-8820
Fax Number	:	714-571-5055

Provider Business Practice Location Address
First Line	:	11620 WILSHIRE BLVD
Second Line	:	STE. 102
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-1706
Country	:	US
Telephone Number	:	310-914-7336
Fax Number	:	310-914-1826

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	JEFFREY SILVERMAN
Credential	:	M.D.
Telephone Number	:	310-914-7336

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	08/26/2008

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Directions to “LANDMARK IMAGING SURGICAL CENTER, LLC ” Practice Location

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