Provider Demographics
NPI:1043694466
Name:INLAND INSTITUTE SURGERY CENTER LLC
Entity Type:Organization
Organization Name:INLAND INSTITUTE SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:H
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-982-8888
Mailing Address - Street 1:1333 E FOOTHILL BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4052
Mailing Address - Country:US
Mailing Address - Phone:909-982-8888
Mailing Address - Fax:909-982-8251
Practice Address - Street 1:1333 E FOOTHILL BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4052
Practice Address - Country:US
Practice Address - Phone:909-982-8888
Practice Address - Fax:909-982-8251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-15
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical