Basic Information
| Provider Information | |||||||||
| NPI: | 1194059246 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INLAND VALLEY SURGICAL CENTER LLC | ||||||||
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| OtherOrganizationName: | INLAND VALLEY SURGERY CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2720 N GAREY AVE | ||||||||
| Address2: | |||||||||
| City: | POMONA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917671810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9095936222 | ||||||||
| FaxNumber: | 9095936299 | ||||||||
| Practice Location | |||||||||
| Address1: | 2720 N GAREY AVE | ||||||||
| Address2: | |||||||||
| City: | POMONA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917671810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9095936222 | ||||||||
| FaxNumber: | 9095936299 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2009 | ||||||||
| LastUpdateDate: | 09/22/2009 | ||||||||
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| AuthorizedOfficialLastName: | HOGUE | ||||||||
| AuthorizedOfficialFirstName: | JEREMY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9497069900 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.