Provider Demographics
NPI:1144272881
Name:WESTERN TUMOR MEDICAL GROUP INC
Entity type:Organization
Organization Name:WESTERN TUMOR MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD, CEO
Authorized Official - Prefix:
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-335-4065
Mailing Address - Street 1:PO BOX 601201
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90060-1201
Mailing Address - Country:US
Mailing Address - Phone:213-744-1460
Mailing Address - Fax:213-744-1486
Practice Address - Street 1:1338 S HOPE ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-2902
Practice Address - Country:US
Practice Address - Phone:213-744-1460
Practice Address - Fax:213-744-1486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0093690Medicaid
CAZZZ76559ZMedicaid
CADD9670OtherRR MEDICARE - CA HOSPITAL
CACF8304OtherRR MEDICARE
CAGR0093691Medicaid
CAZZZ49997ZMedicaid
CACF8304OtherRR MEDICARE
CAGR0093691Medicaid
CAW645CMedicare PIN
CAW645Medicare PIN