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General NPI Number Information
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NPI Number | 1770906141
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Entity Type | Organization
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Legal Business Name | MILLCREEK AMBULATORY SURGERY CENTER
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Dates
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Enumeration Date | 01/21/2014
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Last Update Date | 01/21/2014
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Provider Practice Location Address
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Address Line | 2822 W MAIN ST
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City | VISALIA
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State | CA
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Zip | 93291-4331
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Country | US
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Telephone | 559-625-4119
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Fax | 559-625-9941
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Provider Business Mailing Address
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Address Line | 2822 W MAIN ST
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City | VISALIA
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State | CA
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Zip | 93291-4331
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Country | US
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Telephone | 559-625-4119
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Fax | 559-625-9941
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL B STEVENS
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Credential | M.D., PH.D.
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Telephone | 559-625-8636
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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 | 1200629
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License Number State | CA
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