Provider Demographics
NPI:1922385350
Name:INLAND EMPIRE SURGICAL CENTER LP
Entity Type:Organization
Organization Name:INLAND EMPIRE SURGICAL CENTER LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:R
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-428-2254
Mailing Address - Street 1:381 CORPORATE TERRACE CIR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-6028
Mailing Address - Country:US
Mailing Address - Phone:310-428-2254
Mailing Address - Fax:206-202-2955
Practice Address - Street 1:381 CORPORATE TERRACE CIR
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-6028
Practice Address - Country:US
Practice Address - Phone:310-428-2254
Practice Address - Fax:206-202-2955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical