Provider Demographics
NPI:1932309341
Name:HERNDON SURGERY CENTER, INC.
Entity Type:Organization
Organization Name:HERNDON SURGERY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:DELACRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:559-903-6696
Mailing Address - Street 1:1843 E FIR AVE
Mailing Address - Street 2:SUTE 104
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3841
Mailing Address - Country:US
Mailing Address - Phone:559-903-6696
Mailing Address - Fax:559-252-6767
Practice Address - Street 1:1843 E FIR AVE
Practice Address - Street 2:SUTE 104
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3841
Practice Address - Country:US
Practice Address - Phone:559-903-6696
Practice Address - Fax:559-252-6767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical