MEDICARE: OTOLOGY SURGERY CENTER

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

General Provider Information

NPI Number	:	1285920132
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OTOLOGY SURGERY CENTER

Provider Business Mailing Address
First Line	:	1900 UNIVERSITY AVE STE 101
Second Line	:
City	:	EAST PALO ALTO
State	:	CA
Zip	:	94303-2213
Country	:	US
Telephone Number	:	650-494-1000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1900 UNIVERSITY AVE STE 101
Second Line	:
City	:	EAST PALO ALTO
State	:	CA
Zip	:	94303-2213
Country	:	US
Telephone Number	:	650-494-1000
Fax Number	:

Authorized Official
Title or Position	:	BUSINESS OFFICE DIRECTOR
Name	:	MS. LYDIA BLEVINS
Credential	:
Telephone Number	:	650-494-1000

Provider Enumeration Date	:	06/20/2011
Last Update Date	:	06/20/2011

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