Provider Demographics
NPI:1083944375
Name:OBSERVATORY SURGERY CENTER LLC.
Entity Type:Organization
Organization Name:OBSERVATORY SURGERY CENTER LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/ OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:B
Authorized Official - Last Name:MATOSSIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-462-0681
Mailing Address - Street 1:271 OBSERVATORY AVE
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-5757
Mailing Address - Country:US
Mailing Address - Phone:707-462-2299
Mailing Address - Fax:707-462-1194
Practice Address - Street 1:271 OBSERVATORY AVE
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-5757
Practice Address - Country:US
Practice Address - Phone:707-462-2299
Practice Address - Fax:707-462-1194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-08
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical