MEDICARE: IMAGEBASED SURGICENTER CORPORATION

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	0000694940-AAAHC	CA

General Provider Information

NPI Number	:	1679624233
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IMAGEBASED SURGICENTER CORPORATION

Provider Business Mailing Address
First Line	:	2716 OCEAN PARK BLVD
Second Line	:	SUITE 1007
City	:	SANTA MONICA
State	:	CA
Zip	:	90405-5207
Country	:	US
Telephone Number	:	310-314-6410
Fax Number	:	310-314-2414

Provider Business Practice Location Address
First Line	:	2716 OCEAN PARK BLVD
Second Line	:	SUITE 1007
City	:	SANTA MONICA
State	:	CA
Zip	:	90405-5207
Country	:	US
Telephone Number	:	310-314-6410
Fax Number	:	310-314-2414

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. AARON GERSHON FILLER
Credential	:	M.D. PH.D.
Telephone Number	:	310-314-6410

Provider Enumeration Date	:	01/12/2007
Last Update Date	:	08/22/2020

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