Provider Demographics
NPI:1730466483
Name:HOAG OUTPATIENT CENTERS, LLC
Entity Type:Organization
Organization Name:HOAG OUTPATIENT CENTERS, LLC
Other - Org Name:HOAG ENDOSCOPY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:T
Authorized Official - Last Name:BRAITHWAITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-517-3141
Mailing Address - Street 1:1 HOAG DR
Mailing Address - Street 2:PO BOX 6100
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-4162
Mailing Address - Country:US
Mailing Address - Phone:949-764-4624
Mailing Address - Fax:949-764-5746
Practice Address - Street 1:500 SUPERIOR AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3657
Practice Address - Country:US
Practice Address - Phone:949-764-7580
Practice Address - Fax:949-764-7585
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOAG MEMORIAL HOSPITAL PRESBYTERIAN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-11-09
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical