Provider Demographics
NPI:1821223827
Name:CHINA LAKE SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:CHINA LAKE SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAREK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:760-446-8100
Mailing Address - Street 1:1111 N CHINA LAKE BLVD
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93555-3131
Mailing Address - Country:US
Mailing Address - Phone:760-446-8100
Mailing Address - Fax:760-446-8181
Practice Address - Street 1:1111 N CHINA LAKE BLVD
Practice Address - Street 2:SUITE 2A
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-3131
Practice Address - Country:US
Practice Address - Phone:760-446-8100
Practice Address - Fax:760-446-8181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-19
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical