Healthcare Provider Details

I. General information

NPI: 1083670970
Provider Name (Legal Business Name): GLENWOOD SURGICAL CENTER L P
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8945 MAGNOLIA AVE STE 200
RIVERSIDE CA
92503-4436
US

IV. Provider business mailing address

8945 MAGNOLIA AVE SUITE 200
RIVERSIDE CA
92503-4436
US

V. Phone/Fax

Practice location:
  • Phone: 951-688-7270
  • Fax: 951-352-3736
Mailing address:
  • Phone:
  • 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: CLIFTON MICHAEL FRAZIER
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 951-688-7270