Provider Demographics
NPI:1679534614
Name:COURTYARD SURGERY PAVILION, INC
Entity Type:Organization
Organization Name:COURTYARD SURGERY PAVILION, INC
Other - Org Name:COURTYARD SURGERY PAVILION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STAN
Authorized Official - Middle Name:HARRISON
Authorized Official - Last Name:FEIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-733-4399
Mailing Address - Street 1:112 N AKERS ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-5121
Mailing Address - Country:US
Mailing Address - Phone:559-733-4399
Mailing Address - Fax:559-733-1758
Practice Address - Street 1:112 N AKERS ST
Practice Address - Street 2:SUITE B
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-5121
Practice Address - Country:US
Practice Address - Phone:559-733-4399
Practice Address - Fax:559-733-1758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550000162261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA550000162OtherSTATE LICENSE NUMBER
CABL018923OtherBUSINESS TAX CERTIFICATE
CAZZZH5408ZOtherBLUE SHIELD PROVIDER ID#
CA2732566OtherARTICLES OF INCORPORATION
CAFNP 33532OtherFICTITIOUS NAME PERMIT
05C0001753OtherCMS NUMBER
CACLN 1607OtherPHARMACY CLINIC PERMIT
P00334549OtherMEDICARE RAILROAD #
CASUR01753FMedicaid
CAZZZH5408ZOtherTRICARE PROVIDER#
1942205240OtherSTAN H. FEIL, M.D. (NPI)
CAZZZH5408ZOtherTRICARE PROVIDER#