Provider Demographics
NPI:1255805545
Name:AFFILIATED SURGEONS A MEDICAL CORPORATION
Entity type:Organization
Organization Name:AFFILIATED SURGEONS A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:JANA
Authorized Official - Middle Name:
Authorized Official - Last Name:GROSCOST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-481-3685
Mailing Address - Street 1:26893 BOUQUET CANYON RD STE 217
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91350-3500
Mailing Address - Country:US
Mailing Address - Phone:805-481-3685
Mailing Address - Fax:
Practice Address - Street 1:2802 PACIFIC COAST HWY
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-6702
Practice Address - Country:US
Practice Address - Phone:310-325-1644
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-20
Last Update Date:2019-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty