Provider Demographics
NPI:1487989778
Name:BEVERLY HILLS LASKY SURGERY CENTER
Entity type:Organization
Organization Name:BEVERLY HILLS LASKY SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONSULTANT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:CLOUD
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:310-308-9678
Mailing Address - Street 1:160 S LASKY DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-1704
Mailing Address - Country:US
Mailing Address - Phone:310-247-0003
Mailing Address - Fax:
Practice Address - Street 1:160 S LASKY DR
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-1704
Practice Address - Country:US
Practice Address - Phone:310-247-0003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-05
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAAAASF1371261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAAAASF 1371OtherAMERICAN ASSOCIATIO OF AMBULATORY SURGERY FACILITIES