Provider Demographics
NPI:1407086044
Name:ORANGE COAST SURGERY CENTER
Entity Type:Organization
Organization Name:ORANGE COAST SURGERY CENTER
Other - Org Name:ORANGE COAST MRI
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KRISHNA
Authorized Official - Middle Name:PRASAD
Authorized Official - Last Name:SURAPANENI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-399-0046
Mailing Address - Street 1:1000 S ANAHEIM BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-5804
Mailing Address - Country:US
Mailing Address - Phone:714-399-0046
Mailing Address - Fax:714-399-0049
Practice Address - Street 1:1000 S ANAHEIM BLVD SUITE 300
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-5804
Practice Address - Country:US
Practice Address - Phone:714-399-0046
Practice Address - Fax:714-399-0049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-16
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA49872261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical