Provider Demographics
NPI:1225401672
Name:CHAMPION SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:CHAMPION SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HUU
Authorized Official - Middle Name:
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-842-3595
Mailing Address - Street 1:11244 SNOWDROP AVE
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708
Mailing Address - Country:US
Mailing Address - Phone:714-566-5240
Mailing Address - Fax:
Practice Address - Street 1:4463 BIRCH ST
Practice Address - Street 2:STE 150
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-1911
Practice Address - Country:US
Practice Address - Phone:562-842-3595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-06
Last Update Date:2017-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical