1679534614 NPI number — COURTYARD SURGERY PAVILION, INC

Table of content: (NPI 1679534614)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679534614 NPI number — COURTYARD SURGERY PAVILION, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COURTYARD SURGERY PAVILION, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
COURTYARD SURGERY PAVILION
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679534614
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
112 N AKERS ST
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
VISALIA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93291-5121
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-733-4399
Provider Business Mailing Address Fax Number:
559-733-1758

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
112 N AKERS ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
VISALIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93291-5121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-733-4399
Provider Business Practice Location Address Fax Number:
559-733-1758
Provider Enumeration Date:
03/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FEIL
Authorized Official First Name:
STAN
Authorized Official Middle Name:
HARRISON
Authorized Official Title or Position:
PRESIDENT/MEDICAL DIRECTOR
Authorized Official Telephone Number:
559-733-4399

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  550000162 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 550000162 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: BL018923 . This is a "BUSINESS TAX CERTIFICATE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZH5408Z . This is a "BLUE SHIELD PROVIDER ID#" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 2732566 . This is a "ARTICLES OF INCORPORATION" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: FNP 33532 . This is a "FICTITIOUS NAME PERMIT" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 05C0001753 . This is a "CMS NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: CLN 1607 . This is a "PHARMACY CLINIC PERMIT" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: P00334549 . This is a "MEDICARE RAILROAD #" identifier . This identifiers is of the category "OTHER".
  • Identifier: SUR01753F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZZH5408Z . This is a "TRICARE PROVIDER#" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1942205240 . This is a "STAN H. FEIL, M.D. (NPI)" identifier . This identifiers is of the category "OTHER".




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