Provider Demographics
NPI:1114975794
Name:GROSSMONT SURGERY CENTER, L.P.
Entity Type:Organization
Organization Name:GROSSMONT SURGERY CENTER, L.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPS COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-970-5674
Mailing Address - Street 1:8881 FLETCHER PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3134
Mailing Address - Country:US
Mailing Address - Phone:619-698-0930
Mailing Address - Fax:
Practice Address - Street 1:8881 FLETCHER PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3134
Practice Address - Country:US
Practice Address - Phone:619-698-0930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADUT01090GMedicaid
CAS051090AMedicare ID - Type Unspecified