MEDICARE: SCRIPPS MERCY AMBULATORY SURGERY CENTER, LP

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		CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972668317
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCRIPPS MERCY AMBULATORY SURGERY CENTER, LP

Provider Business Mailing Address
First Line	:	550 WASHINGTON ST
Second Line	:	SUITE 101
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-2213
Country	:	US
Telephone Number	:	619-686-3434
Fax Number	:	619-686-3618

Provider Business Practice Location Address
First Line	:	550 WASHINGTON ST
Second Line	:	SUITE 101
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-2213
Country	:	US
Telephone Number	:	619-686-3434
Fax Number	:	619-686-3618

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. STEVEN MICHAEL GREEN
Credential	:
Telephone Number	:	619-686-3434

Provider Enumeration Date	:	12/26/2006
Last Update Date	:	08/22/2020

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