Provider Demographics
NPI:1548684533
Name:SURGICAL MEDICAL CENTER ON ROXBURY, INC.
Entity type:Organization
Organization Name:SURGICAL MEDICAL CENTER ON ROXBURY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:SOROKURS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-622-5369
Mailing Address - Street 1:435 N. ROXBURY DR.
Mailing Address - Street 2:SUITE 405
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210
Mailing Address - Country:US
Mailing Address - Phone:310-275-2472
Mailing Address - Fax:310-275-2478
Practice Address - Street 1:435 N. ROXBURY DR.
Practice Address - Street 2:SUITE 405
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210
Practice Address - Country:US
Practice Address - Phone:310-275-2472
Practice Address - Fax:310-275-2478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-11
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical