Provider Demographics
NPI:1114091261
Name:WILLOW SURGERY CENTER, A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:WILLOW SURGERY CENTER, A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:B
Authorized Official - Last Name:WEIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-931-2345
Mailing Address - Street 1:203 WILLOW ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-7734
Mailing Address - Country:US
Mailing Address - Phone:415-931-2345
Mailing Address - Fax:415-931-6010
Practice Address - Street 1:203 WILLOW ST
Practice Address - Street 2:SUITE 303
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-7734
Practice Address - Country:US
Practice Address - Phone:415-931-2345
Practice Address - Fax:415-931-6010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical