Provider Demographics
NPI:1841045655
Name:COMMUNITY SURGICAL CENTER, LLC
Entity type:Organization
Organization Name:COMMUNITY SURGICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-324-4720
Mailing Address - Street 1:789 N MEDICAL CENTER DR W
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-6878
Mailing Address - Country:US
Mailing Address - Phone:559-324-4001
Mailing Address - Fax:
Practice Address - Street 1:782 MEDICAL CENTER DR E # 112
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-6889
Practice Address - Country:US
Practice Address - Phone:559-324-4720
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical