Provider Demographics
NPI:1487212197
Name:IRVINE ASC LLC
Entity Type:Organization
Organization Name:IRVINE ASC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-653-7000
Mailing Address - Street 1:18 ENDEAVOR STE 102
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3180
Mailing Address - Country:US
Mailing Address - Phone:949-653-7000
Mailing Address - Fax:949-453-0553
Practice Address - Street 1:18 ENDEAVOR STE 102
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3180
Practice Address - Country:US
Practice Address - Phone:949-653-7000
Practice Address - Fax:949-453-0553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical