MEDICARE: ALVARADO EYE SURGERY CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1114202892
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALVARADO EYE SURGERY CENTER LLC

Provider Business Mailing Address
First Line	:	401 COMMERCE ST
Second Line	:	SUITE 600
City	:	NASHVILLE
State	:	TN
Zip	:	37219-2446
Country	:	US
Telephone Number	:	615-345-6900
Fax Number	:	615-691-7214

Provider Business Practice Location Address
First Line	:	1127 WILSHIRE BLVD STE 1515
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-4006
Country	:	US
Telephone Number	:	213-483-0150
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT, BOARD OF MANAGERS
Name	:	MR. MARK KELLY
Credential	:
Telephone Number	:	615-345-6900

Provider Enumeration Date	:	10/13/2011
Last Update Date	:	01/10/2025

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