Provider Demographics
NPI:1407404379
Name:UNION SQUARE SURGERY CENTER, PC
Entity Type:Organization
Organization Name:UNION SQUARE SURGERY CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEMOLA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:415-845-4638
Mailing Address - Street 1:421 POST ST FL 14
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-1501
Mailing Address - Country:US
Mailing Address - Phone:415-767-1919
Mailing Address - Fax:415-941-3119
Practice Address - Street 1:421 POST ST FL 14
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-1501
Practice Address - Country:US
Practice Address - Phone:415-767-1919
Practice Address - Fax:415-941-3119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-03
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical