Antelope Valley Surgical Associates

Primary specialty

Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X

License

G74861 Issued in CA

Legal business name

ANTELOPE VALLEY SURGICAL ASSOCIATES

Practice address

1331 W Avenue J
Suite 203
Lancaster, CA 93534-2942

Phone

(661) 945-4433

Fax

(661) 940-0206

NPI assigned

May 7, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Pavel Vaclav Petrik, M.D.

Title

Ceo

Phone

(661) 945-4433

Specialties & licenses 2

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178496000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1325548800000",
    "number": "1144433434",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1331 W AVENUE J",
            "address_2": "SUITE 203",
            "city": "LANCASTER",
            "state": "CA",
            "postal_code": "935342942",
            "telephone_number": "661-945-4433",
            "fax_number": "661-940-0206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1331 W AVENUE J",
            "address_2": "SUITE 203",
            "city": "LANCASTER",
            "state": "CA",
            "postal_code": "935342942",
            "telephone_number": "661-945-4433",
            "fax_number": "661-940-0206"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANTELOPE VALLEY SURGICAL ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-07",
        "last_updated": "2012-01-03",
        "status": "A",
        "authorized_official_last_name": "PETRIK",
        "authorized_official_first_name": "PAVEL",
        "authorized_official_middle_name": "VACLAV",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "661-945-4433",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "CA",
            "license": "G74861",
            "primary": true
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "CA",
            "license": "A35504",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0091800",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Antelope Valley Ride Inc.
• Antelope Valley SNF Healthcare, LLC
• Antelope Valley Supportive Care & Hosp
• Antelope Valley Supportive Care and Hospice Non-Profit
• Antelope Valley Surgery Center LP
• Antelope Valley Surgical Institute, LLC
• Antelope Valley Transit Authority
• Antelope Valley Union High School District
• Antelope Valley Urology Medical Group Inc
• Tonya Melynn Anthony, LCSW

• Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician in Lancaster, CA
• Providers in Lancaster, CA by specialty
• Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.