=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851595805
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WESTSIDE SURGICAL SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/13/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | ST. FRANCIS MEDICAL PLAZA 91-2139 FT. WEAVER ROAD, SUITE 310
-----------------------------------------------------
City | EWA BEACH
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-295-5636
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | ST. FRANCIS MEDICAL PLAZA 91-2139 FT. WEAVER ROAD, SUITE 310
-----------------------------------------------------
City | EWA BEACH
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-295-5636
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | DR. ROSS D. SIMAFRANCA
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 808-295-5636
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | MD-14318
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------