Provider Demographics
NPI:1275681579
Name:DOCTORS SURGERY CENTER, A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:DOCTORS SURGERY CENTER, A MEDICAL CORPORATION
Other - Org Name:GUARDIAN SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:FRITZ
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUMGARTNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-285-2385
Mailing Address - Street 1:11037 WARNER AVE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-4007
Mailing Address - Country:US
Mailing Address - Phone:714-285-2385
Mailing Address - Fax:714-962-7261
Practice Address - Street 1:10900 WARNER AVE
Practice Address - Street 2:SUITE 101C
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-3846
Practice Address - Country:US
Practice Address - Phone:714-698-1270
Practice Address - Fax:714-962-7261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05D1037474OtherCLIA ID NUMBER
CAS051716Medicare ID - Type Unspecified
CA05D1037474OtherCLIA ID NUMBER