Healthcare Provider Details

I. General information

NPI: 1306137542
Provider Name (Legal Business Name): PREMIER SURGICENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2011
Last Update Date: 04/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39180 FARWELL DR SUITE 105
FREMONT CA
94538-1052
US

IV. Provider business mailing address

39180 FARWELL DR SUITE 105
FREMONT CA
94538-1052
US

V. Phone/Fax

Practice location:
  • Phone: 510-494-0800
  • Fax: 510-494-0804
Mailing address:
  • Phone: 510-494-0800
  • Fax: 510-494-0804

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: DR. BASIL BESH
Title or Position: MANAGING CONTROL
Credential: M.D.
Phone: 510-494-0800