Provider Demographics
NPI:1053612853
Name:VIP SURGICARE, LLC
Entity type:Organization
Organization Name:VIP SURGICARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:CHURUKIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-358-7000
Mailing Address - Street 1:15047 LOS GATOS BLVD.
Mailing Address - Street 2:SUITE 150
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032
Mailing Address - Country:US
Mailing Address - Phone:408-358-7000
Mailing Address - Fax:408-358-7005
Practice Address - Street 1:15047 LOS GATOS BLVD.
Practice Address - Street 2:SUITE 150
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032
Practice Address - Country:US
Practice Address - Phone:408-358-7000
Practice Address - Fax:408-358-7005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-10
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAAAASF2911261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA129324OtherMEDICARE PTAN
CACA116033OtherMEDICARE PTAN
CAF95947Medicare UPIN