Healthcare Provider Details

I. General information

NPI: 1841045655
Provider Name (Legal Business Name): COMMUNITY SURGICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2024
Last Update Date: 04/23/2024
Certification Date: 04/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

782 MEDICAL CENTER DR E # 112
CLOVIS CA
93611-6889
US

IV. Provider business mailing address

789 N MEDICAL CENTER DR W
CLOVIS CA
93611-6878
US

V. Phone/Fax

Practice location:
  • Phone: 559-324-4720
  • Fax:
Mailing address:
  • Phone: 559-324-4001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. JONATHAN MILLER
Title or Position: MANAGER
Credential:
Phone: 559-324-4720