Provider Demographics
NPI:1508144007
Name:PACIFIC SPECIALIST SURGICAL CENTER LLC
Entity Type:Organization
Organization Name:PACIFIC SPECIALIST SURGICAL CENTER LLC
Other - Org Name:HAYES VALLEY SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRANDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-379-9015
Mailing Address - Street 1:77 VAN NESS AVE
Mailing Address - Street 2:#301
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-6041
Mailing Address - Country:US
Mailing Address - Phone:415-821-8015
Mailing Address - Fax:415-379-9045
Practice Address - Street 1:77 VAN NESS AVE
Practice Address - Street 2:#301
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-6041
Practice Address - Country:US
Practice Address - Phone:415-821-8015
Practice Address - Fax:415-379-9045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-01
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical