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General NPI Number Information
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NPI Number | 1023293008
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Entity Type | Organization
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Legal Business Name | PHYSICIANS TERRACE SURGERY CENTER, LLC
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Dates
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Enumeration Date | 01/08/2008
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Last Update Date | 01/08/2008
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Provider Practice Location Address
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Address Line | 1500 E. CHEVY CHASE DR. SUITE 101
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City | GLENDALE
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State | CA
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Zip | 91206-4150
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Country | US
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Telephone | 818-409-3575
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Fax | 818-546-5694
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Provider Business Mailing Address
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Address Line | 381B MERRILL AVE SUITE 201A
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City | GLENDALE
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State | CA
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Zip | 91206-4119
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Country | US
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Telephone | 818-409-3575
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Fax | 818-546-5694
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | DR. GLENN SILCOTT
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Credential | M.D.
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Telephone | 818-409-3575
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | TO BE APPLIED FOR
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License Number State | CA
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