=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366726465
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INSPIRE HEALTHCARE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/06/2011
-----------------------------------------------------
Last Update Date | 10/06/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 240 N VIRGIL AVE SUITE 6
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90004-5399
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-426-8900
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 240 N VIRGIL AVE SUITE 6
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90004-5399
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-426-8900
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. GREGORY ALAN GERGANS
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 213-426-8900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | G47499
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------