Provider Demographics
NPI:1093758898
Name:MADERA SURGERY CENTER INC.
Entity Type:Organization
Organization Name:MADERA SURGERY CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CONCHAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-673-0700
Mailing Address - Street 1:1015 W YOSEMITE AVE
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93637-4581
Mailing Address - Country:US
Mailing Address - Phone:559-673-0700
Mailing Address - Fax:559-673-0766
Practice Address - Street 1:1015 W YOSEMITE AVE
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93637-4581
Practice Address - Country:US
Practice Address - Phone:559-673-0700
Practice Address - Fax:559-673-0766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAS1797OtherBLUE CROSS/SHIELD
CAZZZ05175ZMedicare PIN