Provider Demographics
NPI:1750308763
Name:SURGICAL SPECIALTIES OF ARROYO GRANDE INC.
Entity Type:Organization
Organization Name:SURGICAL SPECIALTIES OF ARROYO GRANDE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:D
Authorized Official - Last Name:FERRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-474-6383
Mailing Address - Street 1:860 OAK PARK BLVD
Mailing Address - Street 2:102
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-1800
Mailing Address - Country:US
Mailing Address - Phone:805-474-6383
Mailing Address - Fax:805-474-6387
Practice Address - Street 1:860 OAK PARK BLVD
Practice Address - Street 2:102
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-1800
Practice Address - Country:US
Practice Address - Phone:805-474-6383
Practice Address - Fax:805-474-6387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA050000571261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA050000571OtherLICENSE
CA050000571OtherLICENSE