MEDICARE: BEVERLY HILLS AMBULATORY 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	:	1871545707
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEVERLY HILLS AMBULATORY SURGERY CENTER

Provider Business Mailing Address
First Line	:	435 N ROXBURY DR
Second Line	:	STE 106
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90210-5027
Country	:	US
Telephone Number	:	310-278-1839
Fax Number	:

Provider Business Practice Location Address
First Line	:	435 N ROXBURY DR
Second Line	:	STE. 104
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90210-5027
Country	:	US
Telephone Number	:	310-278-1839
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	DR. NORMAN SHORR
Credential	:	M.D.
Telephone Number	:	310-278-1839

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	11/02/2007

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