Provider Demographics
NPI:1821650995
Name:PREMIERE OUTPATIENT SURGERY CENTER CORP
Entity Type:Organization
Organization Name:PREMIERE OUTPATIENT SURGERY CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MAGUED
Authorized Official - Middle Name:
Authorized Official - Last Name:FADLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-225-0045
Mailing Address - Street 1:PO BOX 5699
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91413-5699
Mailing Address - Country:US
Mailing Address - Phone:818-225-0045
Mailing Address - Fax:
Practice Address - Street 1:7325 MEDICAL CENTER DR # 103B
Practice Address - Street 2:
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-1925
Practice Address - Country:US
Practice Address - Phone:818-225-0045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-28
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical