Provider Demographics
NPI:1336223585
Name:PETER T. TRUONG, M.D., SURGICAL CENTER, INC.
Entity Type:Organization
Organization Name:PETER T. TRUONG, M.D., SURGICAL CENTER, INC.
Other - Org Name:RIVERVIEW AMBULATORY SURGICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:T
Authorized Official - Last Name:TRUONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-434-9497
Mailing Address - Street 1:9497 N FORT WASHINGTON
Mailing Address - Street 2:103
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93730-0660
Mailing Address - Country:US
Mailing Address - Phone:559-434-9497
Mailing Address - Fax:559-434-9499
Practice Address - Street 1:9497 N FORT WASHINGTON
Practice Address - Street 2:103
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93730-0660
Practice Address - Country:US
Practice Address - Phone:559-434-9497
Practice Address - Fax:559-434-9499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ05184ZMedicare PIN