Provider Demographics
NPI:1114202892
Name:ALVARADO EYE SURGERY CENTER LLC
Entity Type:Organization
Organization Name:ALVARADO EYE SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, BOARD OF MANAGERS
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-345-6900
Mailing Address - Street 1:401 COMMERCE ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37219-2446
Mailing Address - Country:US
Mailing Address - Phone:615-345-6900
Mailing Address - Fax:615-691-7214
Practice Address - Street 1:1127 WILSHIRE BLVD STE 1515
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-4006
Practice Address - Country:US
Practice Address - Phone:213-483-0150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-13
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical