Healthcare Provider Details

I. General information

NPI: 1114841624
Provider Name (Legal Business Name): GLENN MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1052 WOODBURY DR
HARBOR CITY CA
90710-1241
US

IV. Provider business mailing address

1052 WOODBURY DR
HARBOR CITY CA
90710-1241
US

V. Phone/Fax

Practice location:
  • Phone: 310-922-5054
  • Fax: 424-263-4331
Mailing address:
  • Phone: 310-922-5054
  • Fax: 434-363-4331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CASPER TURNAGE GLENN
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 804-469-0044