Provider Demographics
NPI:1518007608
Name:ROXBURY SURGERY CENTER LLC
Entity Type:Organization
Organization Name:ROXBURY SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SURREY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-246-4628
Mailing Address - Street 1:450 N ROXBURY DR FL 5
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4226
Mailing Address - Country:US
Mailing Address - Phone:310-246-4628
Mailing Address - Fax:310-859-4886
Practice Address - Street 1:450 N ROXBURY DR FL 5
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4226
Practice Address - Country:US
Practice Address - Phone:310-246-4628
Practice Address - Fax:310-859-4886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2029261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical