NPIMap

Organization Active NPI

Miracle Mile Medical Center, LLC

  • General Acute Care Hospital
  • Los Angeles, CA
National Provider Identifier
1184773202
Registry record updated Jun 30, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
930000143 Issued in CA
Legal business name
MIRACLE MILE MEDICAL CENTER, LLC
Practice address
6000 San Vicente Blvd
Los Angeles, CA 90036-4404
Phone
(323) 930-1040
Fax
(323) 937-0525
NPI assigned
Jan 9, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. James K. Theiring
Title
Chief Financial Officer
Phone
(323) 556-3942

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 930000143 CA Primary

Addresses

Primary practice location

6000 San Vicente Blvd
Los Angeles, CA 90036-4404

Mailing address

PO Box 17358
Encino, CA 91416-7358
Phone (323) 930-1040

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

Hospital certification: CCN 050751

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
MIRACLEMILE MEDICAL CENTER
Certification status
Terminated Voluntary: other reason for withdrawal, Dec 28, 2018
Provider type (POS)
Hospital – Short-term
Participating since
Apr 1, 2005
Last certification
May 9, 2019
Beds
17
Ownership / control type
Private (for profit)
Facility address
6000 San Vicente Blvd
Los Angeles, CA 90036

National Provider Directory

National Provider Directory

Locations

17530 Ventura Blvd
Encino, CA 91316
Phone (818) 382-2220

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214784000000",
    "number": "1184773202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 17358",
            "city": "ENCINO",
            "state": "CA",
            "postal_code": "914167358",
            "telephone_number": "323-930-1040",
            "fax_number": "323-937-0525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6000 SAN VICENTE BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900364404",
            "telephone_number": "323-930-1040",
            "fax_number": "323-937-0525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIRACLE MILE MEDICAL CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-09",
        "last_updated": "2008-06-30",
        "status": "A",
        "authorized_official_last_name": "THEIRING",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "K.",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "323-556-3942",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "CA",
            "license": "930000143",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.