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NPI Code Detail

MEDICARE: BEACON COMMUNITY MEDICAL CENTER, INC.

MEDICARE: BEACON COMMUNITY MEDICAL CENTER, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialistA54010CA
2174400000XSpecialist20A8246CA
3111N00000XChiropractorDC29535CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
21962477299OTHERCANPI
31891798674OTHERCANPI
41821091661OTHERCANPI
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1245351808
Entity Type Code : Organization
Provider Name (Legal Business Name) : BEACON COMMUNITY MEDICAL CENTER, INC.
Provider Business Mailing Address
First Line : 2017 W OLYMPIC BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90006-3705
Country : US
Telephone Number : 213-480-1000
Fax Number : 213-401-0018
Provider Business Practice Location Address
First Line : 2017 W OLYMPIC BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90006-3705
Country : US
Telephone Number : 213-480-1000
Fax Number : 213-401-0018
Authorized Official
Title or Position : CEO
Name : DR. WILLIAM JONATHAN PARK
Credential : D.C.
Telephone Number : 213-480-1000
Provider Enumeration Date : 04/02/2007
Last Update Date : 11/19/2007

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