Provider Demographics
NPI:1114168309
Name:MEMORIAL CARE SURGICAL CENTER AT ORANGE COAST, LLC
Entity Type:Organization
Organization Name:MEMORIAL CARE SURGICAL CENTER AT ORANGE COAST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:R
Authorized Official - Last Name:JACOB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-378-7412
Mailing Address - Street 1:18111 BROOKHURST STREET
Mailing Address - Street 2:3200 SUITE
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708
Mailing Address - Country:US
Mailing Address - Phone:951-378-3738
Mailing Address - Fax:
Practice Address - Street 1:18111 BROOKHURST STREET
Practice Address - Street 2:3200 SUITE
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708
Practice Address - Country:US
Practice Address - Phone:951-378-3738
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-17
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical