Provider Demographics
NPI:1689851693
Name:ORTHOPEDIC CENTER FOR EXCELLENCE MEDICAL GROUP A MEDICAL CORP
Entity type:Organization
Organization Name:ORTHOPEDIC CENTER FOR EXCELLENCE MEDICAL GROUP A MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:SADAD
Authorized Official - Last Name:HAMADA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-540-3145
Mailing Address - Street 1:21350 HAWTHORNE BLVD
Mailing Address - Street 2:SUITE 274
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503
Mailing Address - Country:US
Mailing Address - Phone:310-540-3145
Mailing Address - Fax:310-540-2306
Practice Address - Street 1:1300 NO VERMONT AVENUE
Practice Address - Street 2:SUITE 710 DOCTORS TOWER
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027
Practice Address - Country:US
Practice Address - Phone:323-913-4380
Practice Address - Fax:323-913-4381
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORTHOPAEDIC CENTER FOR EXCELLENCE MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-22
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC30470207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
W14084OtherMEDICARE GROUP PROVIDER
CA00C3047000Medicaid
W14084AOtherMEDICARE GROUP PROVIDER
W14084OtherMEDICARE GROUP PROVIDER
WC30470GMedicare PIN
WC30470FMedicare PIN