Provider Demographics
NPI:1689775108
Name:BEVERLY HILLS DOCTORS SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:BEVERLY HILLS DOCTORS SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASC BILLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CANDICE
Authorized Official - Middle Name:M
Authorized Official - Last Name:FURLONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-331-6170
Mailing Address - Street 1:120 S SPALDING DR
Mailing Address - Street 2:SUITE 315 A
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-1800
Mailing Address - Country:US
Mailing Address - Phone:310-275-3304
Mailing Address - Fax:310-275-0418
Practice Address - Street 1:120 S SPALDING DR STE 315A
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-1800
Practice Address - Country:US
Practice Address - Phone:310-275-3304
Practice Address - Fax:310-275-0418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA930000935261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS051456Medicare ID - Type UnspecifiedMEDICARE ID
CACO613AMedicare UPIN