Provider Demographics
NPI:1518079862
Name:ROXBURY SURGICAL ASSOCIATES A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:ROXBURY SURGICAL ASSOCIATES A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:CALVERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-777-8800
Mailing Address - Street 1:PO BOX 940249
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93094-0249
Mailing Address - Country:US
Mailing Address - Phone:805-581-5575
Mailing Address - Fax:310-564-0316
Practice Address - Street 1:465 N ROXBURY DR STE 1001
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4213
Practice Address - Country:US
Practice Address - Phone:310-777-8800
Practice Address - Fax:310-564-0316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
W20267Medicare PIN