Provider Demographics
NPI:1639419104
Name:COMPLETE CARE SURGICAL CENTER LLC
Entity type:Organization
Organization Name:COMPLETE CARE SURGICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MIRIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MACKOVIC-BASIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-634-8812
Mailing Address - Street 1:3650 SOUTH ST
Mailing Address - Street 2:STE 403
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-1502
Mailing Address - Country:US
Mailing Address - Phone:562-634-8812
Mailing Address - Fax:562-634-6033
Practice Address - Street 1:3711 LONG BEACH BLVD
Practice Address - Street 2:STE 101
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-3315
Practice Address - Country:US
Practice Address - Phone:562-424-8422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-21
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical