Provider Demographics
NPI:1821011917
Name:ADVANCED ORTHOPAEDIC SURGERY CENTER
Entity Type:Organization
Organization Name:ADVANCED ORTHOPAEDIC SURGERY CENTER
Other - Org Name:SCOTT HERRON MD
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:HERRON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-693-1505
Mailing Address - Street 1:41278 MARGARITA RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591
Mailing Address - Country:US
Mailing Address - Phone:951-693-1505
Mailing Address - Fax:
Practice Address - Street 1:41278 MARGARITA RD
Practice Address - Street 2:SUITE 201
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591
Practice Address - Country:US
Practice Address - Phone:951-693-1505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG79144207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G791440Medicaid
H03225Medicare UPIN
CA00G791440Medicaid
ZZZ25548ZMedicare ID - Type Unspecified