Beverly Orthopedic Laboratory Inc

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

Legal business name

BEVERLY ORTHOPEDIC LABORATORY INC

Practice address

3000 W Olympic Blvd
#301
Los Angeles, CA 90006

Phone

(213) 351-3556

Fax

(213) 351-3558

NPI assigned

Mar 19, 2021

Last updated

Mar 19, 2021By the provider in NPPES

Organization subpart

Yes

Parent organization

BEVERLY ORTHOPEDIC LABORATORY INCAs reported in NPPES

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

Authorized official

Name

Sanjay Suresh Kawankar, CP, BOCPONPI 1689844813

Title

Ceo, Cfo, Practice Manager

Phone

(323) 727-2887

Specialties & licenses 2

Addresses

Other identifiers 1

Part of

Beverly Orthopedic Laboratory Inc

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Beverly Orthopedic Laboratory Inc

  • Prosthetic/Orthotic Supplier
  • Montebello, CA
  • NPI 1558370023
  NPPES parent name

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Sanjay Suresh Kawankar

  • Prosthetics Case Management
  • Montebello, CA
  • NPI 1689844813
  NPD (past) Authorized official

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

{
    "created_epoch": "1616112000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616112000000",
    "number": "1871179085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3625 W BEVERLY BLVD",
            "city": "MONTEBELLO",
            "state": "CA",
            "postal_code": "90640",
            "telephone_number": "323-727-2887",
            "fax_number": "323-727-2854"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 W OLYMPIC BLVD",
            "address_2": "#301",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90006",
            "telephone_number": "213-351-3556",
            "fax_number": "213-351-3558"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEVERLY ORTHOPEDIC LABORATORY INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BEVERLY ORTHOPEDIC LABORATORY INC",
        "enumeration_date": "2021-03-19",
        "last_updated": "2021-03-19",
        "certification_date": "2021-03-17",
        "status": "A",
        "authorized_official_last_name": "KAWANKAR",
        "authorized_official_first_name": "SANJAY",
        "authorized_official_middle_name": "SURESH",
        "authorized_official_title_or_position": "CEO, CFO, PRACTICE MANAGER",
        "authorized_official_telephone_number": "323-727-2887",
        "authorized_official_credential": "CP, BOCPO"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "XC000815",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Beverly Multispecialty Clinic Inc
• Beverly OB & GYN Medical Center Inc.
• Beverly Radiology Medical Group (Westchester Advanced Imaging)
• Beverly Radiology Medical Group III
• Beverly Surgery Center, Inc
• Beverly West Healthcare, LLC
• Beverly Western Medical Group Inc

• Prosthetic/Orthotic Supplier in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Prosthetic/Orthotic Supplier in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2021; 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.