Provider Demographics
NPI:1417950197
Name:MUSEUM CENTER SURGERY GROUP INC.
Entity Type:Organization
Organization Name:MUSEUM CENTER SURGERY GROUP INC.
Other - Org Name:MIRACLE MILE OUTPATIENT SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:STANLEY
Authorized Official - Last Name:RUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:323-964-0866
Mailing Address - Street 1:5757 WILSHIRE BLVD
Mailing Address - Street 2:PROMENADE 6
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-3681
Mailing Address - Country:US
Mailing Address - Phone:323-964-0866
Mailing Address - Fax:323-964-0868
Practice Address - Street 1:5757 WILSHIRE BLVD
Practice Address - Street 2:PROMENADE 6
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-3681
Practice Address - Country:US
Practice Address - Phone:323-964-0866
Practice Address - Fax:323-964-0868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA930000897261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
S051378BMedicare ID - Type Unspecified