Provider Demographics
NPI:1104087089
Name:CONGRESS MEDICAL SURGERY CENTER LLC
Entity type:Organization
Organization Name:CONGRESS MEDICAL SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:FRAIPONT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-795-8051
Mailing Address - Street 1:PO BOX 90730
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91109-0730
Mailing Address - Country:US
Mailing Address - Phone:626-795-8051
Mailing Address - Fax:626-795-7374
Practice Address - Street 1:800 S RAYMOND AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105
Practice Address - Country:US
Practice Address - Phone:626-795-8051
Practice Address - Fax:626-795-0356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-23
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG81716261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZH1905DOtherBLUE SHIELD
CAP00817840Medicare PIN