MEDICARE: MUSEUM CENTER SURGERY GROUP INC.

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	930000897	CA

General Provider Information

NPI Number	:	1417950197
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MUSEUM CENTER SURGERY GROUP INC.

Provider Business Mailing Address
First Line	:	5757 WILSHIRE BLVD
Second Line	:	PROMENADE 6
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-3681
Country	:	US
Telephone Number	:	323-964-0866
Fax Number	:	323-964-0868

Provider Business Practice Location Address
First Line	:	5757 WILSHIRE BLVD
Second Line	:	PROMENADE 6
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-3681
Country	:	US
Telephone Number	:	323-964-0866
Fax Number	:	323-964-0868

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	DR. HOWARD STANLEY RUBIN
Credential	:	PHD
Telephone Number	:	323-964-0866

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	10/19/2011

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