Basic Information
| Provider Information | |||||||||
| NPI: | 1891963187 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SURGICAL CARE ARCADIA, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | FOOTHILL SURGERY CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 255 E SANTA CLARA ST | ||||||||
| Address2: | SUITE 240 | ||||||||
| City: | ARCADIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 910067226 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6262541800 | ||||||||
| FaxNumber: | 6262541808 | ||||||||
| Practice Location | |||||||||
| Address1: | 255 E SANTA CLARA ST | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | ARCADIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 910067226 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6262541800 | ||||||||
| FaxNumber: | 6262541808 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2008 | ||||||||
| LastUpdateDate: | 02/20/2008 | ||||||||
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| AuthorizedOfficialLastName: | KENNEDY | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6262541800 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.