Provider Demographics
NPI:1477067882
Name:OC GENERAL SURGERY INC
Entity Type:Organization
Organization Name:OC GENERAL SURGERY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-457-7900
Mailing Address - Street 1:26732 CROWN VALLEY PKWY STE 351
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6374
Mailing Address - Country:US
Mailing Address - Phone:949-364-1007
Mailing Address - Fax:
Practice Address - Street 1:26732 CROWN VALLEY PKWY STE 351
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6374
Practice Address - Country:US
Practice Address - Phone:949-364-1007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OC TRAUMA INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-11-21
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma SurgeryGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty