Provider Demographics
NPI:1932153509
Name:NOVAMED SURGERY CENTER OF WHITTIER LLC
Entity Type:Organization
Organization Name:NOVAMED SURGERY CENTER OF WHITTIER LLC
Other - Org Name:CENTER FOR OUTPATIENT SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER AND AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:BOYD
Authorized Official - Last Name:BALDOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-234-5954
Mailing Address - Street 1:15141 WHITTIER BLVD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90603-2135
Mailing Address - Country:US
Mailing Address - Phone:562-945-2832
Mailing Address - Fax:562-945-2174
Practice Address - Street 1:15141 WHITTIER BLVD
Practice Address - Street 2:SUITE 130
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90603-2145
Practice Address - Country:US
Practice Address - Phone:562-945-2832
Practice Address - Fax:562-945-2174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA930000917261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASUR01412GMedicaid
P00285847OtherRR MEDICARE
CA051412OtherBC OF CA
CAZZZH1940BOtherBS OF CA
CASUR01412GMedicaid