Provider Demographics
NPI:1508942996
Name:PHYSICIANS SURGERY SERVICES LP
Entity Type:Organization
Organization Name:PHYSICIANS SURGERY SERVICES LP
Other - Org Name:ADVANCED SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:K
Authorized Official - Last Name:PHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-293-4211
Mailing Address - Street 1:235 OCONNOR DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-1624
Mailing Address - Country:US
Mailing Address - Phone:408-279-0791
Mailing Address - Fax:408-279-0797
Practice Address - Street 1:235 OCONNOR DR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-1624
Practice Address - Country:US
Practice Address - Phone:408-279-0791
Practice Address - Fax:408-279-0797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550000041261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASUR01723FMedicaid
CA05C0001723Medicaid
CASUR01723FMedicaid