Provider Demographics
NPI:1457666885
Name:NEO SURGERY CENTER INC
Entity Type:Organization
Organization Name:NEO SURGERY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:MOELLEKEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-273-1001
Mailing Address - Street 1:120 S SPALDING DR
Mailing Address - Street 2:110
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-1800
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:310-205-4881
Practice Address - Street 1:120 S SPALDING DR
Practice Address - Street 2:110
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-1800
Practice Address - Country:US
Practice Address - Phone:310-273-1001
Practice Address - Fax:310-205-4881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-10
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical