Healthcare Provider Details

I. General information

NPI: 1285048819
Provider Name (Legal Business Name): GS MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2014
Last Update Date: 10/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5550 N PALM AVE SUITE 105
FRESNO CA
93704-1948
US

IV. Provider business mailing address

2980 N BEVERLY GLEN CIR SUITE 100
LOS ANGELES CA
90077-1726
US

V. Phone/Fax

Practice location:
  • Phone: 310-320-1970
  • Fax:
Mailing address:
  • Phone: 310-943-4180
  • Fax: 888-431-8819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License NumberA50680
License Number StateCA

VIII. Authorized Official

Name: GREGORY A. SMITH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 310-320-1970