| Skypark Preferred Family Care Medical Corporation | |
|
23451 Madison St Ste 140 Torrance CA 90505-4736 | |
| (310) 543-1787 | |
| (310) 543-1765 |
| Full Name | Skypark Preferred Family Care Medical Corporation |
|---|---|
| Speciality | Family Medicine |
| Location | 23451 Madison St Ste 140, Torrance, California |
| Authorized Official Name and Position | Thomas W Lagrelius (AUTHORIZED SIGNER) |
| Authorized Official Contact | 3105431787 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Skypark Preferred Family Care Medical Corporation 23451 Madison St Ste 140 Torrance CA 90505-4736 Ph: (310) 543-1787 | Skypark Preferred Family Care Medical Corporation 23451 Madison St Ste 140 Torrance CA 90505-4736 Ph: (310) 543-1787 |
| NPI Number | 1265949960 |
|---|---|
| Provider Enumeration Date | 01/03/2018 |
| Last Update Date | 02/02/2018 |
| Medicare PECOS PAC ID | 7911267455 |
|---|---|
| Medicare Enrollment ID | O20180201001757 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265949960 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Thomas Lagrelius |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1386690915 PECOS PAC ID: 7315132313 Enrollment ID: I20101117000007 |
| Provider Name | Nicole Lawrence |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1508181157 PECOS PAC ID: 9335381300 Enrollment ID: I20130805000508 |
| Provider Name | Jeffrey M Karns |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1407269673 PECOS PAC ID: 8820397177 Enrollment ID: I20160901001379 |
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