Provider Demographics
NPI:1841492543
Name:AFFILIATED SURGICAL ASSOCIATES, PC
Entity type:Organization
Organization Name:AFFILIATED SURGICAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:LIDVIN
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-620-1000
Mailing Address - Street 1:2674 E MAIN ST STE E-928
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-2820
Mailing Address - Country:US
Mailing Address - Phone:805-620-1000
Mailing Address - Fax:805-209-2741
Practice Address - Street 1:760 LAS POSAS RD STE C
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-2910
Practice Address - Country:US
Practice Address - Phone:805-620-1000
Practice Address - Fax:805-209-2741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21784208600000X
208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty