Provider Demographics
NPI:1528185543
Name:GREENBRAE SURGERY CENTER
Entity Type:Organization
Organization Name:GREENBRAE SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:AYCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-925-1700
Mailing Address - Street 1:575 SIR FRANCIS DRAKE BLVD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904-2306
Mailing Address - Country:US
Mailing Address - Phone:415-925-8900
Mailing Address - Fax:415-925-8908
Practice Address - Street 1:575 SIR FRANCIS DRAKE BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-2306
Practice Address - Country:US
Practice Address - Phone:415-925-8900
Practice Address - Fax:415-925-8908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical