=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396748547
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GALILEO SURGERY CENTER, LP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/23/2005
-----------------------------------------------------
Last Update Date | 07/06/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1001 E FOOTHILL BLVD
-----------------------------------------------------
City | SAN LUIS OBISPO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93405-1815
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-782-8222
-----------------------------------------------------
Fax | 805-782-8220
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 5458
-----------------------------------------------------
City | SAN LUIS OBISPO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93403-5458
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-786-4878
-----------------------------------------------------
Fax | 805-597-8350
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING PARTNER
-----------------------------------------------------
Name | MR. BORIS I PILCH
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 805-597-8370
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------