=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194989616
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | USC RADIOLOGY ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/14/2008
-----------------------------------------------------
Last Update Date | 07/14/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1500 SAN PABLO ST 2ND FLOOR IMAGING
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90033-5313
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-442-8541
-----------------------------------------------------
Fax | 323-442-8755
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1500 SAN PABLO ST 2ND FLOOR IMAGING
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90033-5313
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-442-8541
-----------------------------------------------------
Fax | 323-442-8755
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHAIRMAN & PROFESSOR
-----------------------------------------------------
Name | DR. EDWARD G GRANT
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 323-442-8541
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number | F5493
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------