MEDICARE: WARDLOW 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		CA

General Provider Information

NPI Number	:	1982821708
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WARDLOW SURGERY CENTER

Provider Business Mailing Address
First Line	:	660 HAMPSHIRE RD
Second Line	:	200
City	:	WESTLAKE VILLAGE
State	:	CA
Zip	:	91361-2504
Country	:	US
Telephone Number	:	805-497-3736
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 W WARDLOW RD
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-4429
Country	:	US
Telephone Number	:	562-424-3574
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	ANDREE BUCKLEY
Credential	:
Telephone Number	:	805-497-3736

Provider Enumeration Date	:	04/20/2007
Last Update Date	:	03/24/2008

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