Provider Demographics
NPI:1447496468
Name:OLIVE MEDICAL CENTER, INC
Entity type:Organization
Organization Name:OLIVE MEDICAL CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:SPILLANE
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-627-8018
Mailing Address - Street 1:740 S OLIVE ST
Mailing Address - Street 2:SUITE # 102
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90014-2616
Mailing Address - Country:US
Mailing Address - Phone:213-627-8018
Mailing Address - Fax:213-627-0014
Practice Address - Street 1:740 S OLIVE ST
Practice Address - Street 2:SUITE # 102
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90014-2616
Practice Address - Country:US
Practice Address - Phone:213-627-8018
Practice Address - Fax:213-627-0014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-22
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD15996Medicare UPIN