Provider Demographics
NPI:1942585526
Name:BON AIR SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:BON AIR SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-925-8900
Mailing Address - Street 1:575 SIR FRANCIS DRAKE BLVD
Mailing Address - Street 2:SUITE #3
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904-2306
Mailing Address - Country:US
Mailing Address - Phone:415-925-8900
Mailing Address - Fax:415-925-8908
Practice Address - Street 1:575 SIR FRANCIS DRAKE BLVD
Practice Address - Street 2:SUITE #3
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-2306
Practice Address - Country:US
Practice Address - Phone:415-925-8900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-14
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical