MEDICARE: UNIVERSAL CARE SURGERY CENTER, LLC

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	:	1992242192
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSAL CARE SURGERY CENTER, LLC

Provider Business Mailing Address
First Line	:	10866 RIVERSIDE DR
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91602-2236
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10866 RIVERSIDE DR
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91602-2236
Country	:	US
Telephone Number	:	818-980-8300
Fax Number	:	818-980-8301

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. BORIS TRIPOLSKI
Credential	:
Telephone Number	:	818-980-8300

Provider Enumeration Date	:	01/25/2017
Last Update Date	:	02/08/2017

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