Provider Demographics
NPI:1043217615
Name:LONG BEACH SURGERY CENTER, LP
Entity Type:Organization
Organization Name:LONG BEACH SURGERY CENTER, LP
Other - Org Name:SURGERY CENTER OF LONG BEACH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:SNODGRASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-665-1283
Mailing Address - Street 1:20 BURTON HILLS BLVD.
Mailing Address - Street 2:SUITE 500 ATTN: L&C
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:32715-6176
Mailing Address - Country:US
Mailing Address - Phone:615-240-3820
Mailing Address - Fax:615-234-1720
Practice Address - Street 1:2880 ATLANTIC AVENUE
Practice Address - Street 2:SUITE 160
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1715
Practice Address - Country:US
Practice Address - Phone:562-988-9566
Practice Address - Fax:562-997-4597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-28
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS051512Medicare ID - Type Unspecified