Provider Demographics
NPI:1477882199
Name:AMBULATORY CARE SURGICAL CENTER INC
Entity Type:Organization
Organization Name:AMBULATORY CARE SURGICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:LEROY
Authorized Official - Last Name:GERTSCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-974-7200
Mailing Address - Street 1:5225 KEARNY VILLA WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1410
Mailing Address - Country:US
Mailing Address - Phone:858-974-7200
Mailing Address - Fax:858-974-7245
Practice Address - Street 1:5225 KEARNY VILLA WAY
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1410
Practice Address - Country:US
Practice Address - Phone:858-974-7200
Practice Address - Fax:858-974-7245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-08
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA080000458261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF1249Medicare PIN