Provider Demographics
NPI:1942659917
Name:JOURNEY SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:JOURNEY SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:BALKCOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-847-5883
Mailing Address - Street 1:2 JOURNEY
Mailing Address - Street 2:SUITE 200-202
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-3332
Mailing Address - Country:US
Mailing Address - Phone:714-223-7000
Mailing Address - Fax:
Practice Address - Street 1:2 JOURNEY
Practice Address - Street 2:SUITE 200-202
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-3332
Practice Address - Country:US
Practice Address - Phone:714-223-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-09
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical