Basic Information
| Provider Information | |||||||||
| NPI: | 1134349533 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ORANGE COUNTY EMERGENCY SURGICAL SPECIALISTS, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2247 | ||||||||
| Address2: | |||||||||
| City: | ORANGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928590247 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7142891559 | ||||||||
| FaxNumber: | 7142890280 | ||||||||
| Practice Location | |||||||||
| Address1: | 999 N TUSTIN AVE | ||||||||
| Address2: | SUITE 116 | ||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927053528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7145471915 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2007 | ||||||||
| LastUpdateDate: | 03/07/2013 | ||||||||
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| AuthorizedOfficialLastName: | NASTANSKI | ||||||||
| AuthorizedOfficialFirstName: | FRANK | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7142891559 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 146D00000X | A68851 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Emergency Medical Service Providers | Personal Emergency Response Attendant |
ID Information
| ID | Type | State | Issuer | Description | ZZZ50604Y | 01 | CA | BLUE SHIELD | OTHER |