Provider Demographics
NPI:1467647321
Name:ORANGE COUNTY SURGERY CENTER
Entity Type:Organization
Organization Name:ORANGE COUNTY SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MOHSEN
Authorized Official - Middle Name:
Authorized Official - Last Name:TAVOUSSI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-596-1304
Mailing Address - Street 1:18800 DELAWARE ST
Mailing Address - Street 2:SUITE 550
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-1959
Mailing Address - Country:US
Mailing Address - Phone:714-596-1304
Mailing Address - Fax:714-375-0599
Practice Address - Street 1:18800 DELAWARE ST
Practice Address - Street 2:SUITE 550
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-1959
Practice Address - Country:US
Practice Address - Phone:714-596-1304
Practice Address - Fax:714-375-0599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS051452Medicare Oscar/Certification