Provider Demographics
NPI:1740655232
Name:ADVANCED SPECIALTY SURGICAL CENTER, LLC
Entity type:Organization
Organization Name:ADVANCED SPECIALTY SURGICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-348-7246
Mailing Address - Street 1:7230 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-1907
Mailing Address - Country:US
Mailing Address - Phone:818-348-7246
Mailing Address - Fax:818-348-7248
Practice Address - Street 1:625 N A ST
Practice Address - Street 2:SUITE 300
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-4919
Practice Address - Country:US
Practice Address - Phone:805-351-5517
Practice Address - Fax:805-351-5523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-09
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical