| Icm Medical Group, Inc. | |
|
625 E Hardy St Inglewood CA 90301-4106 | |
| (310) 673-6581 | |
| (310) 419-9475 |
| Full Name | Icm Medical Group, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 625 E Hardy St, Inglewood, California |
| Authorized Official Name and Position | Cranford Lavern Scott (CEO/MEDICAL DIRECTOR) |
| Authorized Official Contact | 3106736581 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Icm Medical Group, Inc. 625 E Hardy St Inglewood CA 90301-4106 Ph: (310) 673-6581 | Icm Medical Group, Inc. 625 E Hardy St Inglewood CA 90301-4106 Ph: (310) 673-6581 |
| NPI Number | 1467401000 |
|---|---|
| Provider Enumeration Date | 05/10/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 6709882491 |
|---|---|
| Medicare Enrollment ID | O20061020000336 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467401000 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | 2825600 (California) | Primary |
| Provider Name | Amanuel Sima |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1366493744 PECOS PAC ID: 7012819394 Enrollment ID: I20040126000874 |
| Provider Name | Stuart Edwin Strausberg |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1316065683 PECOS PAC ID: 5698754166 Enrollment ID: I20040717000372 |
| Provider Name | Craig J Gomberg |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1184603128 PECOS PAC ID: 2769496363 Enrollment ID: I20060202000971 |
| Provider Name | Aslan Pirouz |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1770994675 PECOS PAC ID: 2961791645 Enrollment ID: I20160519001122 |
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