=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962586487
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BEVERLY HILLS SURGERY & MEDICAL CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/24/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3737 MARTIN LUTHER KING JR BLVD SUITE 403
-----------------------------------------------------
City | LYNWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90262-3513
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-635-2223
-----------------------------------------------------
Fax | 310-635-2252
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3737 MARTIN LUTHER KING JR BLVD SUITE 403
-----------------------------------------------------
City | LYNWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90262-3513
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-635-2223
-----------------------------------------------------
Fax | 310-635-2252
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | GARY EUGENE FORD
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 310-635-2223
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------