Provider Demographics
NPI:1144287665
Name:CHANNEL ISLANDS SURGICENTER LP
Entity type:Organization
Organization Name:CHANNEL ISLANDS SURGICENTER LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP/SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:SHARFF
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:205-545-2572
Mailing Address - Street 1:2300 WANKEL WAY
Mailing Address - Street 2:PO BOX 6225
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-2665
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2300 WANKEL WAY
Practice Address - Street 2:BOX 6225
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-2665
Practice Address - Country:US
Practice Address - Phone:805-485-1908
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-27
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS051229Medicare PIN