Provider Demographics
NPI:1144309063
Name:SURGITEK OUTPATIENT CENTER INC
Entity type:Organization
Organization Name:SURGITEK OUTPATIENT CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DIRECTOR PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:ELICK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:559-582-0238
Mailing Address - Street 1:460 N GREENFIELD
Mailing Address - Street 2:SUITE #8
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230
Mailing Address - Country:US
Mailing Address - Phone:559-582-0238
Mailing Address - Fax:559-582-9341
Practice Address - Street 1:460 N GREENFIELD
Practice Address - Street 2:SUITE #8
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230
Practice Address - Country:US
Practice Address - Phone:559-582-0238
Practice Address - Fax:559-582-9341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASUR01347GMedicaid
CAZZZ20399ZMedicare ID - Type Unspecified