Organization
PCSC 15 INC
Active
Other names
PACIFIC SURGERY CENTER OF VTA
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KEITH WINTERMUTE (ADMINISTRATOR)
(805) 644-9001
Entity
Organization
Contact information
Practice address
3805 TELEGRAPH RD, VENTURA, CA 93003-3422
(805) 644-9001
(805) 654-1103
Mailing address
3805 TELEGRAPH RD, VENTURA, CA 93003-3422
(805) 644-9001
(805) 654-1103
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
050000581
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
005279
BLUE CROSS PROV. #
CA
01
—
99204
HEALTH PARTNERS PROV. #
CA
01
—
ZZZH5616Z
BLUE SHIELD PROV. #
CA
Enumeration date
10/16/2006
Last updated
04/28/2008
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