Provider Demographics
NPI:1891732202
Name:VISALIA CENTER FOR AMBULATORY MEDICINE AND SURGERY
Entity Type:Organization
Organization Name:VISALIA CENTER FOR AMBULATORY MEDICINE AND SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BURTON
Authorized Official - Middle Name:
Authorized Official - Last Name:REDD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-635-9556
Mailing Address - Street 1:111 E NOBLE AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-2700
Mailing Address - Country:US
Mailing Address - Phone:559-635-9556
Mailing Address - Fax:559-637-2274
Practice Address - Street 1:111 E NOBLE AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-2700
Practice Address - Country:US
Practice Address - Phone:559-635-9556
Practice Address - Fax:559-637-2274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ94498ZMedicare ID - Type Unspecified