Provider Demographics
NPI:1366643751
Name:SPECIALTY SURGICAL CENTER OF THOUSAND OAKS, L.P.
Entity Type:Organization
Organization Name:SPECIALTY SURGICAL CENTER OF THOUSAND OAKS, L.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER AND AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:BOYD
Authorized Official - Last Name:BALDOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-234-5954
Mailing Address - Street 1:696 HAMPSHIRE ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361
Mailing Address - Country:US
Mailing Address - Phone:805-413-7920
Mailing Address - Fax:805-413-7921
Practice Address - Street 1:696 HAMPSHIRE ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-4456
Practice Address - Country:US
Practice Address - Phone:805-413-7920
Practice Address - Fax:805-413-7921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QA1903X
261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS051849Medicare PIN