Provider Demographics
NPI:1902576234
Name:CONCOURSE DIAGNOSTIC SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:CONCOURSE DIAGNOSTIC SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF NURSING
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:MC CHUANG
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:626-872-0347
Mailing Address - Street 1:707 S GARFIELD AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-5860
Mailing Address - Country:US
Mailing Address - Phone:626-872-0347
Mailing Address - Fax:626-872-0340
Practice Address - Street 1:707 S GARFIELD AVE STE 101
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-5860
Practice Address - Country:US
Practice Address - Phone:626-872-0347
Practice Address - Fax:626-872-0340
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CONCOURSE DIAGNOSTIC AND SURGERY CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-09-17
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty