Provider Demographics
NPI:1629753413
Name:EMPIRE SURGICAL CENTER
Entity Type:Organization
Organization Name:EMPIRE SURGICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:NAVID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-515-7174
Mailing Address - Street 1:4480 MILLS CIR
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764-5206
Mailing Address - Country:US
Mailing Address - Phone:909-515-7174
Mailing Address - Fax:
Practice Address - Street 1:4480 MILLS CIR
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-5206
Practice Address - Country:US
Practice Address - Phone:909-515-7174
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical