Provider Demographics
NPI:1952560740
Name:SK CLLINIC SURGICAL CENTER
Entity Type:Organization
Organization Name:SK CLLINIC SURGICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE BILLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:F
Authorized Official - Last Name:BREMSETH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-454-3161
Mailing Address - Street 1:528 NAUTILUS ST
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-6138
Mailing Address - Country:US
Mailing Address - Phone:858-454-3161
Mailing Address - Fax:858-454-0790
Practice Address - Street 1:528 NAUTILUS ST
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-6138
Practice Address - Country:US
Practice Address - Phone:858-454-3161
Practice Address - Fax:858-454-0790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-05
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG029780261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
A91223Medicare UPIN
CAG29780Medicare PIN