Provider Demographics
NPI:1417183336
Name:MADISON 101 PASADENA, LLC
Entity Type:Organization
Organization Name:MADISON 101 PASADENA, LLC
Other - Org Name:MADISON 101 PASADENA SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:SCHWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-793-5134
Mailing Address - Street 1:960 E GREEN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-2401
Mailing Address - Country:US
Mailing Address - Phone:626-793-5134
Mailing Address - Fax:626-793-2912
Practice Address - Street 1:960 E GREEN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-2401
Practice Address - Country:US
Practice Address - Phone:626-793-5134
Practice Address - Fax:626-793-2912
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MADISON 101 PASADENA, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-05
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10275261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA10275OtherINSTITUTE FOR MEDICAL QUALITY AMBULATORY PROGRAM