Provider Demographics
NPI:1245765924
Name:PARADISE SURGERY CENTER
Entity Type:Organization
Organization Name:PARADISE SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:
Authorized Official - Last Name:NISWONGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-514-8282
Mailing Address - Street 1:6283 CLARK RD
Mailing Address - Street 2:SUITE 11
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95969-4100
Mailing Address - Country:US
Mailing Address - Phone:530-514-8282
Mailing Address - Fax:
Practice Address - Street 1:6283 CLARK RD
Practice Address - Street 2:SUITE 11
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-4100
Practice Address - Country:US
Practice Address - Phone:530-514-8282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-01
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA05C001855261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical