Healthcare Provider Details

I. General information

NPI: 1811137557
Provider Name (Legal Business Name): THOMAS L. HEDGE, M.D. A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2009
Last Update Date: 02/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18300 ROSCOE BLVD 4IFL TOWER
NORTHRIDGE CA
91325-4167
US

IV. Provider business mailing address

PO BOX 8300
NORTHRIDGE CA
91327-8300
US

V. Phone/Fax

Practice location:
  • Phone: 818-885-5342
  • Fax: 818-727-1451
Mailing address:
  • Phone: 661-618-1771
  • Fax: 661-287-9471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P0004X
TaxonomySpinal Cord Injury Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHIRLEY VIOLA JOHNSON
Title or Position: ADMINISTRATOR
Credential:
Phone: 661-618-1771