South Gate Ambulatory Surgical Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

E2739 Issued in CA

Legal business name

SOUTH GATE AMBULATORY SURGICAL CENTER, LLC

Practice address

3425 Firestone Blvd
South Gate, CA 90280-3029

Phone

(323) 566-1183

Fax

(323) 566-5348

NPI assigned

Feb 27, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Barry A Richmond, D.P.M.

Title

President

Phone

(323) 566-1183

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Ambulatory surgical center certification: CCN 05C0001843

Legal name

SOUTH GATE AMBULATORY SURGERY CENTER, LLC

Certification status

Active

Provider type (POS)

Ambulatory surgical center

Participating since

Mar 20, 2008

Last certification

Oct 6, 2011

Ownership / control type

Government

Facility address

3425 Firestone Boulevard
South Gate, CA 90280

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

{
    "created_epoch": "1172534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1477680684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3425 FIRESTONE BLVD",
            "city": "SOUTH GATE",
            "state": "CA",
            "postal_code": "902803029",
            "telephone_number": "323-566-1183",
            "fax_number": "323-566-5348"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3425 FIRESTONE BLVD",
            "city": "SOUTH GATE",
            "state": "CA",
            "postal_code": "902803029",
            "telephone_number": "323-566-1183",
            "fax_number": "323-566-5348"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH GATE AMBULATORY SURGICAL CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "RICHMOND",
        "authorized_official_first_name": "BARRY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "323-566-1183",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.P.M."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "CA",
            "license": "E2739",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Ambulatory Surgical Clinic/Center in South Gate, CA
• Providers in South Gate, CA by specialty
• Ambulatory Surgical Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.