Provider Demographics
NPI:1457643405
Name:COFFEE SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:COFFEE SURGERY CENTER, LLC
Other - Org Name:ALL KIDS DENTAL SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICKIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:KASPRZYK
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:209-338-8368
Mailing Address - Street 1:2525 EYE ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-2064
Mailing Address - Country:US
Mailing Address - Phone:662-131-4813
Mailing Address - Fax:
Practice Address - Street 1:2525 EYE ST
Practice Address - Street 2:SUITE 100
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-2064
Practice Address - Country:US
Practice Address - Phone:209-338-8368
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-10
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PENDING261QA1903X, 261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental