Provider Demographics
NPI:1942522628
Name:INTEGRATED SURGERY CENTER LLC
Entity Type:Organization
Organization Name:INTEGRATED SURGERY CENTER LLC
Other - Org Name:INTEGRATED SURGERY CENTER LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NISSANOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-855-0752
Mailing Address - Street 1:POST OFFICE BOX 269092
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-9092
Mailing Address - Country:US
Mailing Address - Phone:310-855-0752
Mailing Address - Fax:
Practice Address - Street 1:8670 WILSHIRE BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2924
Practice Address - Country:US
Practice Address - Phone:310-855-0752
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-22
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical