Provider Demographics
NPI:1902044969
Name:SCRIPPS SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:SCRIPPS SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:GLYNN
Authorized Official - Last Name:BOLITHO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-458-5100
Mailing Address - Street 1:9834 GENESEE AVE
Mailing Address - Street 2:307
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1223
Mailing Address - Country:US
Mailing Address - Phone:858-458-5100
Mailing Address - Fax:858-458-1550
Practice Address - Street 1:9834 GENESEE AVE
Practice Address - Street 2:307
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1223
Practice Address - Country:US
Practice Address - Phone:858-458-5100
Practice Address - Fax:858-458-1550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-29
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical