Provider Demographics
NPI:1801822739
Name:SYLVAN SURGERY CENTER, INC.
Entity Type:Organization
Organization Name:SYLVAN SURGERY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MAGDY
Authorized Official - Middle Name:
Authorized Official - Last Name:ELSAKR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-338-0393
Mailing Address - Street 1:2336 SYLVAN AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-9211
Mailing Address - Country:US
Mailing Address - Phone:209-338-0393
Mailing Address - Fax:209-338-0398
Practice Address - Street 1:2336 SYLVAN AVE
Practice Address - Street 2:SUITE B
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-9211
Practice Address - Country:US
Practice Address - Phone:209-338-0393
Practice Address - Fax:209-338-0398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550000147261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASUR01780FMedicaid
CA550000147OtherSTATE LICENSE #
CASUR01780FMedicaid
CAZZZ05025ZMedicare PIN