Provider Demographics
NPI:1447232756
Name:APPLE VALLEY SURGERY CENTER
Entity Type:Organization
Organization Name:APPLE VALLEY SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BO MANGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHNATEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:DILLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-241-8000
Mailing Address - Street 1:18122 US HIGHWAY 18
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-2202
Mailing Address - Country:US
Mailing Address - Phone:760-946-1170
Mailing Address - Fax:760-946-2646
Practice Address - Street 1:16850 BEAR VALLEY RD
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-5794
Practice Address - Country:US
Practice Address - Phone:760-241-8000
Practice Address - Fax:760-951-2034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ25640ZMedicare ID - Type UnspecifiedMEDICARE TAX ID