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NPI Code Detail

MEDICARE: VISTA HOSPITAL OF SOUTH BAY, LP

MEDICARE: VISTA HOSPITAL OF SOUTH BAY, LP
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
1282E00000XLong Term Care HospitalCA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1619061660
Entity Type Code : Organization
Provider Name (Legal Business Name) : VISTA HOSPITAL OF SOUTH BAY, LP
Provider Business Mailing Address
First Line : 1246 W 155TH ST
Second Line :
City : GARDENA
State : CA
Zip : 90247-4011
Country : US
Telephone Number : 310-323-5330
Fax Number : 310-768-2265
Provider Business Practice Location Address
First Line : 1246 W 155TH ST
Second Line :
City : GARDENA
State : CA
Zip : 90247-4011
Country : US
Telephone Number : 310-323-5330
Fax Number : 310-768-2265
Authorized Official
Title or Position : SENIOR VP
Name : MARC C FERRELL
Credential :
Telephone Number : 562-715-0974
Provider Enumeration Date : 10/03/2006
Last Update Date : 10/24/2007

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Directions to “VISTA HOSPITAL OF SOUTH BAY, LP ” Practice Location

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