SOURCE SURGERY CENTER LLC (NPI# 1558802249) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1558802249 |
| Entity Type | Organization |
| Organization Name | SOURCE SURGERY CENTER LLC |
| Practice Address |
2801 Wilshire Blvd Santa Monica CA 90403-4801 |
| Mailing Address |
1112 Montana Ave Suite 900 Santa Monica CA 90403-1652 |
| Practice Telephone | 3105742777 |
| Practice Fax Number | 3103154968 |
| Mailing Telephone | 3105742777 |
| Mailing Fax Number | 3103154968 |
| Enumeration Date | 2017-03-14 |
| Last Update Date | 2020-01-21 |
| Authorized Official Name | DR. TIMOTHY T DAVIS (OWNER) |
| Authorized Official Telephone | 3105742777 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QA1903X |
Clinic/Center Specialization: Ambulatory Surgical |
Ambulatory Health Care Facilities |
| Street Address |
2801 WILSHIRE BLVD |
| City | SANTA MONICA |
| State | CA |
| Zip Code | 90403-4801 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427520972 | Isobel Gardner | Marriage & Family Therapist | 2730 Wilshire Boulevard #650, Santa Monica, CA 90403 | 2018-12-21 |
| 1477030369 | Jennifer Garcia | Dentist | 2901 Wilshire Blvd Ste 255, Santa Monica, CA 90403 | 2018-07-23 |
| 1215435847 | The Balance Lab Physical Therapy and Fitness | Physical Therapist | 2924 Wilshire Blvd, Santa Monica, CA 90403 | 2018-01-29 |
| 1306354634 | Sea Change Santa Monica, Lp | Clinic/Center | 1051 Princeton St, Santa Monica, CA 90403 | 2018-01-22 |
| 1114446226 | Jafary Foot & Ankle Specialists LLC | Podiatrist | 2121 Wilshire Blvd Ste 101, Santa Monica, CA 90403 | 2017-09-11 |
| 1023553906 | Jory Faermark | Speech-Language Pathologist | 1158 26th Street, #417, Santa Monica, CA 90403 | 2016-12-30 |
| 1376095042 | William Michael Thornton | Chiropractor | 2118 Wilshire Blvd, #577, Santa Monica, CA 90403 | 2016-10-28 |
| 1801251723 | Lisa Lavoie | Naturopath | 1-935 Euclid St, Santa Monica, CA 90403 | 2015-12-18 |
| 1376915793 | Lisa Hanes | Marriage & Family Therapist | 1150 Yale Street, Suite 2, Santa Monica, CA 90403 | 2015-10-25 |
| 1386015386 | Natalie Kazarian | Marriage & Family Therapist | 2116 Wilshire Blvd Ste 241, Santa Monica, CA 90403 | 2015-10-15 |
| Find all providers in zip 90403 | ||||
| Taxonomy Code | 261QA1903X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Ambulatory Surgical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255972642 | Santa Monica Advanced Surgical Institute LLC | Clinic/Center | 1908 Santa Monica Blvd Ste 5, Santa Monica, CA 90404-1927 | 2019-10-07 |
| 1083255616 | Younique Surgery Center | Clinic/Center | 1317 5th St Ste 301, Santa Monica, CA 90401-1459 | 2019-10-04 |
| 1912369703 | Select Surgical, A Medical Corporation | Clinic/Center | 1223 Wilshire Blvd Ste 594, Santa Monica, CA 90403-5406 | 2016-03-22 |
| 1144502170 | Omega Surgical Center, Inc. | Clinic/Center | 2730 Wilshire Blvd Ste 500, Santa Monica, CA 90403-4752 | 2011-09-15 |
| 1235376674 | Core Surgery Center Inc | Clinic/Center | 2336 Santa Monica Blvd Ste 304, Santa Monica, CA 90404-2067 | 2009-01-07 |
| 1053556670 | Santa Monica Outpatient Surgery Center | Clinic/Center | 2001 Santa Monica Blvd., Suite 1180w, Santa Monica, CA 90404 | 2008-12-10 |
| 1679694392 | Directed Interventional Surgery Ctr Inc A Professional Medical Corp | Clinic/Center | 2827 Wilshire Blvd, Santa Monica, CA 90403-4801 | 2007-04-02 |
| 1578605044 | Broadway Surgical Institute, LLC | Clinic/Center | 1451 S Broadway Street, Santa Monica, CA 90404-1811 | 2007-02-13 |
| 1740335744 | Aesthetic Surgical Center of Santa Monica | Clinic/Center | 1301 20th St Ste 350, Santa Monica, CA 90404-2052 | 2007-01-23 |
| 1427692037 | Biohealth Surgical Institute | Clinic/Center | 1451 Broadway, Santa Monica, CA 90404-2711 | 2019-11-06 |
| Find all providers in SANTA MONICA | ||||
| City | SANTA MONICA |
| Zip Code | 90403 |
Please comment or provide details below to improve the information on SOURCE SURGERY CENTER LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.