Provider Demographics
NPI:1952698078
Name:EXECUTIVE SURGERY CENTER, INC.
Entity Type:Organization
Organization Name:EXECUTIVE SURGERY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SALIM
Authorized Official - Middle Name:
Authorized Official - Last Name:SHELBY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-963-0759
Mailing Address - Street 1:1320 EL CAPITAN DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-6258
Mailing Address - Country:US
Mailing Address - Phone:925-963-0759
Mailing Address - Fax:
Practice Address - Street 1:1320 EL CAPITAN DR
Practice Address - Street 2:SUITE 100
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526-6258
Practice Address - Country:US
Practice Address - Phone:925-963-0759
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-10
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69275261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical