Provider Demographics
NPI:1003990219
Name:PACIFIC SURGICAL INSTITUTE, A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:PACIFIC SURGICAL INSTITUTE, A MEDICAL CORPORATION
Other - Org Name:PACIFIC SURGICAL INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:T
Authorized Official - Last Name:GINSBURG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-372-4500
Mailing Address - Street 1:3531 FASHION WAY STE 3
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-3809
Mailing Address - Country:US
Mailing Address - Phone:310-372-4500
Mailing Address - Fax:310-372-4505
Practice Address - Street 1:3531 FASHION WAY STE 3
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-3809
Practice Address - Country:US
Practice Address - Phone:310-372-4500
Practice Address - Fax:310-372-4505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G747892Medicaid
CAWG74789AMedicaid