Basic Information
| Provider Information | |||||||||
| NPI: | 1578994265 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | M/S SURGERY CENTER LLC | ||||||||
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| OtherOrganizationName: | M/S SURGERY CENTER LLC WHIT | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3510 MARTIN LUTHER KING JR BLVD | ||||||||
| Address2: | |||||||||
| City: | LYNWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902622010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3106389391 | ||||||||
| FaxNumber: | 3106038749 | ||||||||
| Practice Location | |||||||||
| Address1: | 7957 PAINTER AVE | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | WHITTIER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906022434 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3106389391 | ||||||||
| FaxNumber: | 3106038749 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2013 | ||||||||
| LastUpdateDate: | 12/05/2013 | ||||||||
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| AuthorizedOfficialLastName: | SHAMMAS | ||||||||
| AuthorizedOfficialFirstName: | HANNA | ||||||||
| AuthorizedOfficialMiddleName: | F | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3106389391 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.