Provider Demographics
NPI:1275532889
Name:COAST SURGERY CENTER L P
Entity Type:Organization
Organization Name:COAST SURGERY CENTER L P
Other - Org Name:COAST SURGERY CENTER OF SOUTH BAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER, AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:BOON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-567-0269
Mailing Address - Street 1:3445 PACIFIC COAST HWY
Mailing Address - Street 2:STE 110
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-6658
Mailing Address - Country:US
Mailing Address - Phone:310-325-4555
Mailing Address - Fax:310-325-5005
Practice Address - Street 1:3445 PACIFIC COAST HWY
Practice Address - Street 2:STE 110
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-6658
Practice Address - Country:US
Practice Address - Phone:310-325-4555
Practice Address - Fax:310-325-5005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-15
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLN794261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00080885OtherRAILROAD MEDICARE
CAP00080885OtherRAILROAD MEDICARE