Provider Demographics
NPI:1275214876
Name:UNIVERSITY SURGICAL INSTITUTE LLC
Entity Type:Organization
Organization Name:UNIVERSITY SURGICAL INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:KHOURY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-459-0314
Mailing Address - Street 1:8200 STOCKDALE HWY
Mailing Address - Street 2:SUITE M-10 #287
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-1029
Mailing Address - Country:US
Mailing Address - Phone:248-459-0314
Mailing Address - Fax:661-402-3540
Practice Address - Street 1:2120 19TH ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-3709
Practice Address - Country:US
Practice Address - Phone:248-459-0314
Practice Address - Fax:661-402-3540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical