Provider Demographics
NPI:1124361282
Name:BEVERLY HILLS LASKY CLINIC SURGERY CENTER
Entity Type:Organization
Organization Name:BEVERLY HILLS LASKY CLINIC SURGERY CENTER
Other - Org Name:BEVERLY HILLS LASKY SURGICENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL BILLING MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:CLOUD
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:323-301-2178
Mailing Address - Street 1:160 S LASKY DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-1704
Mailing Address - Country:US
Mailing Address - Phone:323-301-2178
Mailing Address - Fax:866-844-4712
Practice Address - Street 1:152 S LASKY DR
Practice Address - Street 2:SUITE 106
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-1720
Practice Address - Country:US
Practice Address - Phone:323-301-2178
Practice Address - Fax:866-844-4712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-27
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAJACHO 538887261QA1903X
CAAAAASF 1371261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1371OtherAAAASF CERTIFICATION
CA538887OtherJOINT COMISSION