Provider Demographics
NPI:1336466036
Name:GROSSMAN SURGI CENTER INC.
Entity Type:Organization
Organization Name:GROSSMAN SURGI CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:H
Authorized Official - Last Name:GROSSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACS
Authorized Official - Phone:818-981-2050
Mailing Address - Street 1:7325 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-1925
Mailing Address - Country:US
Mailing Address - Phone:818-981-2050
Mailing Address - Fax:
Practice Address - Street 1:7325 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 204
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-1925
Practice Address - Country:US
Practice Address - Phone:818-981-2050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GROSSMAN MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-04-21
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG66484174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty