NPIMap

Organization Active NPI

Golden State Otolaryngology Medical Corporation

  • Specialist
  • Lancaster, CA
National Provider Identifier
1568660611
Registry record updated Feb 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
A69121 Issued in CA
Legal business name
GOLDEN STATE OTOLARYNGOLOGY MEDICAL CORPORATION
Practice address
44105 15TH St W Ste 202
Lancaster, CA 93534-4090
Phone
(661) 726-6277
Fax
(661) 726-6291
NPI assigned
Jul 10, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 11, 2008

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

Authorized official

Name
Mrs. Ruwanthi S Campano, M.D.NPI 1023018389
Title
President
Phone
(661) 726-6277

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X A69121 CA Primary

Addresses

Primary practice location

44105 15TH St W Ste 202
Lancaster, CA 93534-4090

Mailing address

PO Box 6558
Lancaster, CA 93539-6558
Phone (661) 726-6277

Other identifiers 1

IdentifierTypeStateIssuer
ZZZ64933ZOtherCABLUE SHIELD

Other names 1

  • GSOMC-Billing Other name

National Provider Directory

National Provider Directory
Tax ID family
Golden State Otolaryngology3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 3

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": "1184025600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202688000000",
    "number": "1568660611",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6558",
            "city": "LANCASTER",
            "state": "CA",
            "postal_code": "935396558",
            "telephone_number": "661-726-6277",
            "fax_number": "661-726-6291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44105 15TH ST W STE 202",
            "city": "LANCASTER",
            "state": "CA",
            "postal_code": "935344090",
            "telephone_number": "661-726-6277",
            "fax_number": "661-726-6291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOLDEN STATE OTOLARYNGOLOGY MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-10",
        "last_updated": "2008-02-11",
        "status": "A",
        "authorized_official_last_name": "CAMPANO",
        "authorized_official_first_name": "RUWANTHI",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "661-726-6277",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "A69121",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ64933Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GSOMC-Billing",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Lancaster, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.