Provider Demographics
NPI:1023365913
Name:PS CENTER, LLC
Entity Type:Organization
Organization Name:PS CENTER, LLC
Other - Org Name:PACIFIC SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOORE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:949-478-8000
Mailing Address - Street 1:1640 NEWPORT BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-3786
Mailing Address - Country:US
Mailing Address - Phone:949-478-8000
Mailing Address - Fax:949-478-8001
Practice Address - Street 1:1640 NEWPORT BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-3786
Practice Address - Country:US
Practice Address - Phone:949-478-8000
Practice Address - Fax:949-478-8001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical