Provider Demographics
NPI:1255729166
Name:A & C SURGERY CENTER, LLC
Entity type:Organization
Organization Name:A & C SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:WILSON
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:818-386-1395
Mailing Address - Street 1:16055 VENTURA BLVD STE 712
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2610
Mailing Address - Country:US
Mailing Address - Phone:818-386-1395
Mailing Address - Fax:888-882-6061
Practice Address - Street 1:16055 VENTURA BLVD STE 712
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2610
Practice Address - Country:US
Practice Address - Phone:818-386-1395
Practice Address - Fax:888-882-6061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-30
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical