Central Coast Facial Surgery Center
Organization Active NPI Ambulatory Surgical Clinic/Center · Templeton, CA
NPI 1083671358 · NPPES record last updated Aug 21, 2007
Key facts
- NPI
- 1083671358
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Ambulatory Surgical Clinic/Center 261QA1903X
- License
- FNP26330 (CA)
- Legal business name
- CENTRAL COAST FACIAL SURGERY CENTER
- Practice address
- 295 Posada LN
Suite B
Templeton, CA 93465-4055 - Phone
- (805) 434-5960
- Fax
- (805) 434-5963
- NPI assigned
- Apr 28, 2006
- Organization subpart
- No
Authorized official
- Name
- Dr. Roman P Bukachevsky, M.D.
- Title
- Member-Manager
- Phone
- (805) 434-5960
Practitioners 1
-
Roman Platon Bukachevsky, M.D.
Medicare Care Compare: Ambulatory surgical center
- Listed as
- Central Coast Facial Surgery Center
- Medicare certification status
- Active
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070727000350 | CA | Part B Supplier - Ambulatory Surgical Center | 3678674132 | Practice locations: Templeton, CA |
National Provider Directory
Locations
295 Posada Ln
Ste B
Templeton, CA 93465
Phone (805) 434-5960
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ambulatory Surgical Clinic/Center | 261QA1903X | FNP26330 | CA | Yes |
Addresses
Primary practice location
295 Posada LN
Suite B
Templeton, CA 93465-4055
Mailing address
295 Posada LN
Suite B
Templeton, CA 93465-4055
Phone (805) 434-5960
Other providers in Templeton, CA
- Central Coast Associated Physicians, Inc.
- Central Coast Clinical Laboratory, Inc
- Central Coast Direct Medical Care PC
- Central Coast DPM, Inc
- Central Coast Emergency Physicians
- Central Coast Foot & Ankle Specialists
- Central Coast Gastroenterology Medical Group
- Central Coast Obstetrics & Gynecology, Inc.
- Central Coast Pediatrics Inc
- Central Coast Radiology Medical Group Inc
All providers in Templeton, CA · Ambulatory Surgical Clinic/Center in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 21, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.