Provider Demographics
NPI:1780293472
Name:ADVANCED SURGICAL CENTER OF NEWPORT BEACH, LLC
Entity type:Organization
Organization Name:ADVANCED SURGICAL CENTER OF NEWPORT BEACH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO PRIME MSO
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:
Authorized Official - Last Name:TCHAMANIAN
Authorized Official - Suffix:
Authorized Official - Credentials:CASC
Authorized Official - Phone:818-937-9968
Mailing Address - Street 1:550 N BRAND BLVD STE 900
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-4721
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:351 HOSPITAL RD STE 005
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3509
Practice Address - Country:US
Practice Address - Phone:949-999-2499
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCED SURGICAL CENTERS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-07-28
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical