Provider Demographics
NPI:1922440122
Name:CROW CANYON SURGERY CENTER, INC.
Entity Type:Organization
Organization Name:CROW CANYON SURGERY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SALIM
Authorized Official - Middle Name:
Authorized Official - Last Name:SHELBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-413-0808
Mailing Address - Street 1:1320 EL CAPITAN DR STE 100
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-6260
Mailing Address - Country:US
Mailing Address - Phone:925-866-9300
Mailing Address - Fax:
Practice Address - Street 1:1320 EL CAPITAN DR STE 100
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526-6260
Practice Address - Country:US
Practice Address - Phone:925-866-9300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-29
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical