Provider Demographics
NPI:1922038165
Name:BIRCH MEDICAL OFFICE CENTER, LLC
Entity Type:Organization
Organization Name:BIRCH MEDICAL OFFICE CENTER, LLC
Other - Org Name:BIRCH MEDICAL IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:KANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-221-1700
Mailing Address - Street 1:20162 SW BIRCH ST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-0787
Mailing Address - Country:US
Mailing Address - Phone:949-221-1700
Mailing Address - Fax:949-221-1704
Practice Address - Street 1:20162 SW BIRCH ST
Practice Address - Street 2:SUITE 150
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-0787
Practice Address - Country:US
Practice Address - Phone:949-221-1700
Practice Address - Fax:949-221-1704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19353Medicare ID - Type Unspecified