Provider Demographics
NPI:1578994265
Name:M/S SURGERY CENTER LLC
Entity Type:Organization
Organization Name:M/S SURGERY CENTER LLC
Other - Org Name:M/S SURGERY CENTER LLC WHIT
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HANNA
Authorized Official - Middle Name:F
Authorized Official - Last Name:SHAMMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-638-9391
Mailing Address - Street 1:3510 MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:LYNWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90262-2010
Mailing Address - Country:US
Mailing Address - Phone:310-638-9391
Mailing Address - Fax:310-603-8749
Practice Address - Street 1:7957 PAINTER AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-2434
Practice Address - Country:US
Practice Address - Phone:310-638-9391
Practice Address - Fax:310-603-8749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-05
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS551041AMedicare PIN