Provider Demographics
NPI:1770728438
Name:UNIVERSITY OF SOUTHERN CALIFORNIA
Entity type:Organization
Organization Name:UNIVERSITY OF SOUTHERN CALIFORNIA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SVP & CEO, KECK MEDICINE OF USC
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:JACKIEWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-442-9775
Mailing Address - Street 1:1441 EASTLAKE AVENUE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90089-0112
Mailing Address - Country:US
Mailing Address - Phone:323-442-8444
Mailing Address - Fax:323-442-5257
Practice Address - Street 1:1441 EASTLAKE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90089-0112
Practice Address - Country:US
Practice Address - Phone:323-865-3000
Practice Address - Fax:323-865-0159
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNICERSITY OF SOUTHERN CALIFOR
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-10
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA930000267282N00000X
CA282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHSC30660GMedicaid
CAHSP40660GMedicaid
CAHSC30660GMedicaid
CA050660Medicare Oscar/Certification