Provider Demographics
NPI:1477502318
Name:PALMDALE LANCASTER SURGERY CENTER
Entity Type:Organization
Organization Name:PALMDALE LANCASTER SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ECKO
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNARDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-729-3910
Mailing Address - Street 1:42442 10TH ST W
Mailing Address - Street 2:SUITE G
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-7067
Mailing Address - Country:US
Mailing Address - Phone:661-729-3910
Mailing Address - Fax:661-729-3970
Practice Address - Street 1:42442 10TH ST W
Practice Address - Street 2:SUITE G
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-7067
Practice Address - Country:US
Practice Address - Phone:661-729-3910
Practice Address - Fax:661-729-3970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA930000956261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASUR01504FMedicaid
CAS051504Medicare ID - Type Unspecified