Provider Demographics
NPI:1821181488
Name:ADVANCED SURGERY MEDICAL CENTER, LLC
Entity Type:Organization
Organization Name:ADVANCED SURGERY MEDICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDAL
Authorized Official - Middle Name:T
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-998-8109
Mailing Address - Street 1:989 STORY RD
Mailing Address - Street 2:8066
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95122-4603
Mailing Address - Country:US
Mailing Address - Phone:408-998-8109
Mailing Address - Fax:408-295-1205
Practice Address - Street 1:989 STORY RD
Practice Address - Street 2:8066
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122-4603
Practice Address - Country:US
Practice Address - Phone:408-998-8109
Practice Address - Fax:408-295-1205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery