Provider Demographics
NPI:1902851009
Name:90210 SURGERY MEDICAL CENTER, LLC
Entity Type:Organization
Organization Name:90210 SURGERY MEDICAL CENTER, LLC
Other - Org Name:90210 SURGERY MEDICAL CENTER AT LINDEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GIESSLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-207-3716
Mailing Address - Street 1:3033 N 44TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-7244
Mailing Address - Country:US
Mailing Address - Phone:480-207-3737
Mailing Address - Fax:623-266-0053
Practice Address - Street 1:9735 WILSHIRE BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-2107
Practice Address - Country:US
Practice Address - Phone:310-601-3900
Practice Address - Fax:310-601-3905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05C0001745Medicare Oscar/Certification
CAS051745Medicare PIN
CAY52154Medicare UPIN