Provider Demographics
NPI:1396748547
Name:GALILEO SURGERY CENTER, LP
Entity type:Organization
Organization Name:GALILEO SURGERY CENTER, LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:I
Authorized Official - Last Name:PILCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-597-8370
Mailing Address - Street 1:PO BOX 5458
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93403-5458
Mailing Address - Country:US
Mailing Address - Phone:805-786-4878
Mailing Address - Fax:805-597-8350
Practice Address - Street 1:1001 E FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-1815
Practice Address - Country:US
Practice Address - Phone:805-782-8222
Practice Address - Fax:805-782-8220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05C0001448Medicaid
CACB235712OtherMEDICARE PTAN
CAS051448OtherMEDICARE PTAN