Provider Demographics
NPI:1538258116
Name:NEUROSCIENCES INSTITUTE OF THE HOSPITAL OF THE GOOD SAMARITAN
Entity type:Organization
Organization Name:NEUROSCIENCES INSTITUTE OF THE HOSPITAL OF THE GOOD SAMARITAN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:INO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-977-2121
Mailing Address - Street 1:PO BOX 17959
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-0959
Mailing Address - Country:US
Mailing Address - Phone:213-481-0592
Mailing Address - Fax:213-481-0108
Practice Address - Street 1:1245 WILSHIRE BLVD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-4810
Practice Address - Country:US
Practice Address - Phone:213-977-2140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATP108Medicare PIN