Provider Demographics
NPI:1003001967
Name:ROXBURY CLINIC AND SURGERY CENTER INC
Entity type:Organization
Organization Name:ROXBURY CLINIC AND SURGERY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF NURSING
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHONA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:310-248-6250
Mailing Address - Street 1:465 N ROXBURY DR
Mailing Address - Street 2:SUITE 1001
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4206
Mailing Address - Country:US
Mailing Address - Phone:310-248-6250
Mailing Address - Fax:310-248-6258
Practice Address - Street 1:465 N ROXBURY DR
Practice Address - Street 2:SUITE 1001
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4206
Practice Address - Country:US
Practice Address - Phone:310-248-6250
Practice Address - Fax:310-248-6258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS051658Medicare PIN