Provider Demographics
NPI:1730123571
Name:TWIN CITIES SURGICENTER, INC.
Entity Type:Organization
Organization Name:TWIN CITIES SURGICENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:WASILENKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-741-3937
Mailing Address - Street 1:812 4TH ST
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95901-5667
Mailing Address - Country:US
Mailing Address - Phone:530-741-3937
Mailing Address - Fax:530-741-2109
Practice Address - Street 1:812 4TH ST
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:CA
Practice Address - Zip Code:95901-5667
Practice Address - Country:US
Practice Address - Phone:530-741-3937
Practice Address - Fax:530-741-2109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC26467261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery