Provider Demographics
NPI:1407806904
Name:UNIVERSITY SURGEONS OF ORANGE A MEDICAL GROUP
Entity Type:Organization
Organization Name:UNIVERSITY SURGEONS OF ORANGE A MEDICAL GROUP
Other - Org Name:UNIVERSITY SURGEONS OF ORANGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:UPS PROVIDER RELATIONS
Authorized Official - Prefix:DR
Authorized Official - First Name:UCI HEALTH
Authorized Official - Middle Name:
Authorized Official - Last Name:PROVIDER RELATIONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-456-2986
Mailing Address - Street 1:PO BOX 31001-2446
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91110-2446
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 THE CITY DR S
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868
Practice Address - Country:US
Practice Address - Phone:714-456-7212
Practice Address - Fax:714-456-7601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No204F00000XAllopathic & Osteopathic PhysiciansTransplant SurgeryGroup - Multi-Specialty
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical CareGroup - Multi-Specialty
No2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric SurgeryGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Multi-Specialty
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ54076ZOtherBLUE SHIELD GROUP #
CAGR0052890OtherMEDI-CAL GROUP #
CAZZZ54072ZOtherBLUE SHIELD GROUP #
CAZZZ54079ZOtherBLUE SHIELD GROUP #
CAZZZ54264ZOtherBLUE SHIELD GROUP #
CAZZZ54068ZOtherBLUE SHIELD GROUP #
CAZZZ54074ZOtherBLUE SHIELD GROUP #
CAW11770Medicare ID - Type UnspecifiedMEDICARE GROUP #