Provider Demographics
NPI:1982220612
Name:ADVANCED ORTHOPAEDIC SURGEONS AT LONG BEACH, INC
Entity Type:Organization
Organization Name:ADVANCED ORTHOPAEDIC SURGEONS AT LONG BEACH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BUSH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:562-961-5655
Mailing Address - Street 1:1760 TERMINO AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-2151
Mailing Address - Country:US
Mailing Address - Phone:562-961-5655
Mailing Address - Fax:562-961-8836
Practice Address - Street 1:1760 TERMINO AVE STE 208
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-2151
Practice Address - Country:US
Practice Address - Phone:562-961-5655
Practice Address - Fax:562-961-8836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-18
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G598090Medicaid