Provider Demographics
NPI:1740318153
Name:PLAZA SURGERY CENTER, L.P.
Entity type:Organization
Organization Name:PLAZA SURGERY CENTER, L.P.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-739-3600
Mailing Address - Street 1:525 PLAZA DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-6953
Mailing Address - Country:US
Mailing Address - Phone:805-739-3809
Mailing Address - Fax:805-739-3887
Practice Address - Street 1:525 PLAZA DR
Practice Address - Street 2:SUITE 100
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-6953
Practice Address - Country:US
Practice Address - Phone:805-739-3809
Practice Address - Fax:805-739-3887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA050000578261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
651190935OtherIRS - SP TAS ID
CA7498486OtherAETNA
CACGP171469Medicaid
ZZZH4213ZOtherBLUE SHIELD OF CA
CASUR01620FMedicaid
CASUR01620FMedicaid
CACGP171469Medicaid
CA=========OtherIRS
651190935OtherIRS - SP TAS ID
CACGP171469Medicaid