MEDICARE: FAMILY & URGENT CARE MEDICAL CENTER

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
1	305S00000X	Point of Service

General Provider Information

NPI Number	:	1477848141
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY & URGENT CARE MEDICAL CENTER

Provider Business Mailing Address
First Line	:	1200 N VERMONT AVE
Second Line	:	SUITE A
City	:	LOS ANGELES
State	:	CA
Zip	:	90029-1760
Country	:	US
Telephone Number	:	323-666-2220
Fax Number	:	323-666-2226

Provider Business Practice Location Address
First Line	:	1200 N VERMONT AVE
Second Line	:	SUITE A
City	:	LOS ANGELES
State	:	CA
Zip	:	90029-1760
Country	:	US
Telephone Number	:	323-666-2220
Fax Number	:	323-666-2226

Authorized Official
Title or Position	:	GENERAL MANAGER
Name	:	MR. AHMED HAMZA
Credential	:
Telephone Number	:	323-666-2220

Provider Enumeration Date	:	06/10/2011
Last Update Date	:	06/10/2011

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