Provider Demographics
NPI:1255607149
Name:LA SURGICAL SERVICES, LLC
Entity type:Organization
Organization Name:LA SURGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, BILLING
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-382-1292
Mailing Address - Street 1:6339 E SPEEDWAY BLVD
Mailing Address - Street 2:STE. 201
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-1147
Mailing Address - Country:US
Mailing Address - Phone:520-547-4130
Mailing Address - Fax:520-258-0304
Practice Address - Street 1:2202 S FIGUEROA ST
Practice Address - Street 2:STE. 6001
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90007-2049
Practice Address - Country:US
Practice Address - Phone:520-547-4130
Practice Address - Fax:520-258-0304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-26
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QA1903X
CA261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical