Healthcare Provider Details

I. General information

NPI: 1104969179
Provider Name (Legal Business Name): TEHACHAPI SURGERY CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 11/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20960 SAGE LN STE A
TEHACHAPI CA
93561-6408
US

IV. Provider business mailing address

20960 SAGE LN STE A
TEHACHAPI CA
93561-6408
US

V. Phone/Fax

Practice location:
  • Phone: 661-822-2890
  • Fax: 661-822-2892
Mailing address:
  • Phone: 661-822-2890
  • Fax: 661-822-2892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MARSHALL LEWIS
Title or Position: DIRECTOR
Credential: M.D.
Phone: 661-822-2890