Provider Demographics
NPI:1548551377
Name:FREMONT ASC PARTNERS, LLC
Entity type:Organization
Organization Name:FREMONT ASC PARTNERS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:GHARAATI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-791-5200
Mailing Address - Street 1:2675 STEVENSON BLVD
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-2317
Mailing Address - Country:US
Mailing Address - Phone:510-791-5200
Mailing Address - Fax:510-791-5201
Practice Address - Street 1:2675 STEVENSON BLVD
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-2317
Practice Address - Country:US
Practice Address - Phone:510-791-5200
Practice Address - Fax:510-791-5201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-27
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95304OtherAAAHC CERTIFICATION
CAF1984OtherMEDICARE PTAN
CA95304OtherAAAHC CERTIFICATION