PREMIER SURGICAL PAVILION OF LA
NPI 1114589793
Clinic/Center - Ambulatory Surgical in Los Angeles, CA
- Organization
- Clinic/Center
- Ambulatory Surgical
- CLIA Number: 05D2194751
- CLIA Cert. Type: Ambulatory Surgery Center
- CLIA Exp. Date: 10-01-2026
About PREMIER SURGICAL PAVILION OF LA
This page provides the complete NPI Profile along with additional information for Premier Surgical Pavilion Of La, a provider established in Los Angeles, California operating as a Clinic/center, focusing in ambulatory surgical . The healthcare provider is registered in the NPI registry with number 1114589793 assigned on July 2019. The practitioner's primary taxonomy code is 261QA1903X. The provider is registered as an organization and their NPI record was last updated 7 years ago. The authorized official of this NPI record is Dr. Michael Eugene Jones Md (Medical Director)
- NPI
- 1114589793 Verify this NPI
- Provider Name
- PREMIER SURGICAL PAVILION OF LA
- Entity Type
- Organization
- Location Address
- 11661 SAN VICENTE BLVD LOS ANGELES, CA 90049
- Location Phone
- (212) 223-0716
- Mailing Address
- 115 E 39TH ST NEW YORK, NY 10016
- Mailing Phone
- (212) 223-0716
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 07-03-2019
- Last Update Date
- 07-03-2019
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Clinic/Center Ambulatory Surgical
- Taxonomy Code
- 261QA1903X
- Type
- Ambulatory Health Care Facilities
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| C53266 | OTHER (01) | CA | MEDICAL LICENSE |
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 05D2194751
- Facility Type
- Ambulatory Surgery Center
- Certificate Effective Date
- October 02, 2024
- Certificate Expiration Date
- October 01, 2026
- Laboratory Director
- MICHAEL E. JONES
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Premier Surgical Pavilion Of La to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
Reviews for PREMIER SURGICAL PAVILION OF LA
There are currently no reviews for this provider. Be the first person to share your experience with this provider by filling out our review form. Your insights are appreciated and will help others make informed decisions.
Other Providers at the Same Location
The following 5 providers are registered at the same or a nearby location.
LOS ANGELES, CA 90049
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1114589793, enumerated as an "organization" on July 03, 2019.
The provider is located at 11661 SAN VICENTE BLVD LOS ANGELES, CA 90049 and the phone number is (212) 223-0716.
Clinic/Center with taxonomy code 261QA1903X and a focus in Ambulatory Surgical.
The provider might be accepting Accepts: Medicare and Medicaid. Please consult your insurance carrier or call the provider to verify.
