Provider Demographics
NPI:1427487982
Name:SAMARITAN TOWER SURGERY CENTER, LLC
Entity type:Organization
Organization Name:SAMARITAN TOWER SURGERY CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:DAMIAN
Authorized Official - Last Name:MINOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-977-1077
Mailing Address - Street 1:1127 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-3901
Mailing Address - Country:US
Mailing Address - Phone:213-977-1077
Mailing Address - Fax:213-977-1073
Practice Address - Street 1:1127 WILSHIRE BLVD
Practice Address - Street 2:SUITE 1000
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-3901
Practice Address - Country:US
Practice Address - Phone:213-977-1077
Practice Address - Fax:213-977-1073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-05
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain