Healthcare Provider Details

I. General information

NPI: 1841240157
Provider Name (Legal Business Name): ARDENT HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2131 W 3RD ST ST VINCENT MEDICAL CENTER
LOS ANGELES CA
90057-1901
US

IV. Provider business mailing address

PO BOX 80089
CITY OF INDUSTRY CA
91716-8089
US

V. Phone/Fax

Practice location:
  • Phone: 213-484-7410
  • Fax:
Mailing address:
  • Phone: 213-484-7410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: WALTER L WYNNE
Title or Position: PRESDIENT
Credential: M.D.
Phone: 213-484-7410