Healthcare Provider Details

I. General information

NPI: 1720023484
Provider Name (Legal Business Name): SPALDING TRIANGLE SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 05/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 S SPALDING DR STE 115
BEVERLY HILLS CA
90212-1800
US

IV. Provider business mailing address

120 S SPALDING DR STE 115
BEVERLY HILLS CA
90212-1800
US

V. Phone/Fax

Practice location:
  • Phone: 424-542-8485
  • Fax: 424-542-8487
Mailing address:
  • Phone: 424-542-8485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number550000124
License Number StateCA

VIII. Authorized Official

Name: DAVID W ODELL
Title or Position: MANAGING MEMBER
Credential:
Phone: 805-679-7560