| Brookdale Medical Center Inc | |
|
2809 Tweedy Blvd South Gate CA 90280 | |
| (323) 567-9909 | |
| (323) 567-9929 |
| Full Name | Brookdale Medical Center Inc |
|---|---|
| Speciality | Pediatrics |
| Location | 2809 Tweedy Blvd, South Gate, California |
| Authorized Official Name and Position | John Barkodar (PRESIDENT) |
| Authorized Official Contact | 3235679909 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Brookdale Medical Center Inc 2809 Tweedy Blvd South Gate CA 90280 Ph: (323) 567-9909 | Brookdale Medical Center Inc 2809 Tweedy Blvd South Gate CA 90280 Ph: (323) 567-9909 |
| NPI Number | 1265572903 |
|---|---|
| Provider Enumeration Date | 02/08/2007 |
| Last Update Date | 12/23/2010 |
| Medicare PECOS PAC ID | 1557541489 |
|---|---|
| Medicare Enrollment ID | O20110210000393 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265572903 | NPI | - | NPPES |
| GR0102030 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | OA44541 (California) | Secondary |
| 208000000X | Pediatrics | OA44541 (California) | Primary |
| Provider Name | Linda Barkodar |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1124288147 PECOS PAC ID: 6406040443 Enrollment ID: I20101103000664 |
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