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General NPI Number Information
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NPI Number | 1720023484
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Entity Type | Organization
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Legal Business Name | SPALDING TRIANGLE SURGERY CENTER, LLC
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Dates
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Enumeration Date | 06/18/2006
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Last Update Date | 05/07/2018
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Provider Practice Location Address
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Address Line | 120 S SPALDING DR STE 115
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City | BEVERLY HILLS
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State | CA
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Zip | 90212-1800
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Country | US
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Telephone | 424-542-8485
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Fax | 424-542-8487
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Provider Business Mailing Address
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Address Line | 120 S SPALDING DR STE 115
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City | BEVERLY HILLS
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State | CA
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Zip | 90212-1800
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Country | US
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Telephone | 424-542-8485
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DAVID W ODELL
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Credential |
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Telephone | 805-679-7560
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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 | 550000124
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License Number State | CA
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