Provider Demographics
NPI:1083211643
Name:ALPHA SURGERY CENTER LLC
Entity Type:Organization
Organization Name:ALPHA SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:E
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:MEDICAL DOCTOR
Authorized Official - Phone:818-986-9099
Mailing Address - Street 1:4910 VAN NUYS BLVD STE 306
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-1770
Mailing Address - Country:US
Mailing Address - Phone:818-986-9099
Mailing Address - Fax:818-986-9089
Practice Address - Street 1:4910 VAN NUYS BLVD STE 306
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-1770
Practice Address - Country:US
Practice Address - Phone:818-986-9099
Practice Address - Fax:818-986-9089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-07
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical