Provider Demographics
NPI:1922828284
Name:KECK MEDICINE OF USC SURGERY CENTER, PASADENA - LLC
Entity type:Organization
Organization Name:KECK MEDICINE OF USC SURGERY CENTER, PASADENA - LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO/USC CARE MEDICAL GROUP, INC.
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHURCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-442-8747
Mailing Address - Street 1:590 S FAIR OAKS AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-2614
Mailing Address - Country:US
Mailing Address - Phone:323-442-8747
Mailing Address - Fax:
Practice Address - Street 1:590 S FAIR OAKS AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2614
Practice Address - Country:US
Practice Address - Phone:323-442-8747
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KECK MEDICINE OF USC SURGERY CENTERS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-10-11
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical