MEDICARE: ROXBURY DR OUTPATIENT SURG CTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center		CA

General Provider Information

NPI Number	:	1255527776
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROXBURY DR OUTPATIENT SURG CTR

Provider Business Mailing Address
First Line	:	435 N ROXBURY DR STE 200
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90210-5004
Country	:	US
Telephone Number	:	818-273-4160
Fax Number	:

Provider Business Practice Location Address
First Line	:	435 N ROXBURY DR STE 200
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90210-5004
Country	:	US
Telephone Number	:	818-273-4160
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	HARVEY S RICHMOND
Credential	:	MD
Telephone Number	:	310-273-4160

Provider Enumeration Date	:	09/18/2007
Last Update Date	:	04/20/2008

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