Provider Demographics
NPI:1861702359
Name:INLAND OUTPATIENT SURGERY CENTER, INC.
Entity type:Organization
Organization Name:INLAND OUTPATIENT SURGERY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:THIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-600-7702
Mailing Address - Street 1:41670 IVY ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-9432
Mailing Address - Country:US
Mailing Address - Phone:951-600-7702
Mailing Address - Fax:951-600-5935
Practice Address - Street 1:4217 LUTHER ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2853
Practice Address - Country:US
Practice Address - Phone:951-600-7702
Practice Address - Fax:951-600-5935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG04612Medicare UPIN