Provider Demographics
NPI:1912362955
Name:ST CHARLES SURGICAL CENTER
Entity Type:Organization
Organization Name:ST CHARLES SURGICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:LIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-557-7050
Mailing Address - Street 1:550 SAINT CHARLES DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-3951
Mailing Address - Country:US
Mailing Address - Phone:805-557-7050
Mailing Address - Fax:805-557-4992
Practice Address - Street 1:550 SAINT CHARLES DR
Practice Address - Street 2:SUITE 101
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-3951
Practice Address - Country:US
Practice Address - Phone:805-557-7050
Practice Address - Fax:805-557-4992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-17
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical