Provider Demographics
NPI:1013499730
Name:EVOLVE SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:EVOLVE SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRODY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:310-982-2004
Mailing Address - Street 1:10866 WASHINGTON BLVD.
Mailing Address - Street 2:SUITE 160
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232
Mailing Address - Country:US
Mailing Address - Phone:310-982-2004
Mailing Address - Fax:
Practice Address - Street 1:3831 HUGHES AVE.
Practice Address - Street 2:SUITE 700
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232
Practice Address - Country:US
Practice Address - Phone:310-982-2004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical