MEDICARE: AFFILIATED SURGICAL ASSOCIATES, PC

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	208600000X	Surgery Physician	21784	AZ
2	208600000X	Surgery Physician

General Provider Information

NPI Number	:	1841492543
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AFFILIATED SURGICAL ASSOCIATES, PC

Provider Business Mailing Address
First Line	:	2674 E MAIN ST STE E-928
Second Line	:
City	:	VENTURA
State	:	CA
Zip	:	93003-2820
Country	:	US
Telephone Number	:	805-620-1000
Fax Number	:	805-209-2741

Provider Business Practice Location Address
First Line	:	760 LAS POSAS RD STE C
Second Line	:
City	:	CAMARILLO
State	:	CA
Zip	:	93010-2910
Country	:	US
Telephone Number	:	805-620-1000
Fax Number	:	805-209-2741

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	TERRY LIDVIN SIMPSON
Credential	:	MD
Telephone Number	:	805-620-1000

Provider Enumeration Date	:	06/04/2007
Last Update Date	:	06/09/2022

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