Provider Demographics
NPI:1457917320
Name:INTEGRATED SURGICAL CENTER
Entity Type:Organization
Organization Name:INTEGRATED SURGICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:MS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:COMPLIANCE
Authorized Official - Phone:805-719-6611
Mailing Address - Street 1:550 SAINT CHARLES DR STE 101
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-3971
Mailing Address - Country:US
Mailing Address - Phone:805-719-6611
Mailing Address - Fax:805-719-6622
Practice Address - Street 1:550 SAINT CHARLES DR STE 101
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-3971
Practice Address - Country:US
Practice Address - Phone:805-719-6611
Practice Address - Fax:805-719-6622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-15
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical