Provider Demographics
NPI:1407116361
Name:MONTEREY PENINSULA SURGERY CENTER CAPITOLA
Entity Type:Organization
Organization Name:MONTEREY PENINSULA SURGERY CENTER CAPITOLA
Other - Org Name:CAPITOLA SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-372-2169
Mailing Address - Street 1:966 CASS ST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-4539
Mailing Address - Country:US
Mailing Address - Phone:831-372-2169
Mailing Address - Fax:831-372-6323
Practice Address - Street 1:2265 41ST AVE
Practice Address - Street 2:
Practice Address - City:CAPITOLA
Practice Address - State:CA
Practice Address - Zip Code:95010-2039
Practice Address - Country:US
Practice Address - Phone:831-372-2169
Practice Address - Fax:831-372-6323
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MONTEREY PENINSULA SURGERY CENTERS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-05-24
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical