| Sc Physician Group | |
|
946 N Brand Blvd Glendale CA 91202-2905 | |
| (818) 662-7000 | |
| (818) 662-7131 |
| Full Name | Sc Physician Group |
|---|---|
| Speciality | Family Medicine |
| Location | 946 N Brand Blvd, Glendale, California |
| Authorized Official Name and Position | Manuel P Momjian (PRESIDENT) |
| Authorized Official Contact | 6266166642 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sc Physician Group 946 N Brand Blvd Glendale CA 91202-2905 Ph: (626) 616-6642 | Sc Physician Group 946 N Brand Blvd Glendale CA 91202-2905 Ph: (818) 662-7000 |
| NPI Number | 1316198997 |
|---|---|
| Provider Enumeration Date | 10/01/2008 |
| Last Update Date | 04/17/2014 |
| Medicare PECOS PAC ID | 6103980958 |
|---|---|
| Medicare Enrollment ID | O20090123000128 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316198997 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | A98448 (California) | Primary |
| 261QU0200X | Clinic/center - Urgent Care | A98448 (California) | Secondary |
| Provider Name | Jarlath Ryan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1639360449 PECOS PAC ID: 2567543010 Enrollment ID: I20080122000800 |
| Provider Name | Manuel Momjian |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1609060185 PECOS PAC ID: 7810051661 Enrollment ID: I20090123000181 |
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