MEDICARE: SHERMAN OAKS EMERGENCY MEDICAL ASSOCIATES

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	207P00000X	Emergency Medicine Physician		CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518904150
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHERMAN OAKS EMERGENCY MEDICAL ASSOCIATES

Provider Business Mailing Address
First Line	:	PO BOX 80616
Second Line	:
City	:	CITY OF INDUSTRY
State	:	CA
Zip	:	91716-8411
Country	:	US
Telephone Number	:	310-321-0143
Fax Number	:	310-379-4856

Provider Business Practice Location Address
First Line	:	4929 VAN NUYS BLVD
Second Line	:
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91403-1702
Country	:	US
Telephone Number	:	310-379-2134
Fax Number	:	310-379-4856

Authorized Official
Title or Position	:	PRESIDENT
Name	:	IRV EDWARDS
Credential	:	M.D.
Telephone Number	:	310-321-0143

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	07/21/2022

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