Basic Information
| Provider Information | |||||||||
| NPI: | 1588692644 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MEDICAL CENTER OF GARDEN GROVE | ||||||||
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| OtherOrganizationName: | GARDEN GROVE HOSPITAL /MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | FILE 57483 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900747483 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6263004122 | ||||||||
| FaxNumber: | 7147413322 | ||||||||
| Practice Location | |||||||||
| Address1: | 12601 GARDEN GROVE BLVD | ||||||||
| Address2: | |||||||||
| City: | GARDEN GROVE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928431908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7145375160 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2006 | ||||||||
| LastUpdateDate: | 10/17/2013 | ||||||||
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| AuthorizedOfficialLastName: | ARMIN | ||||||||
| AuthorizedOfficialFirstName: | CRAIG | ||||||||
| AuthorizedOfficialMiddleName: | C. | ||||||||
| AuthorizedOfficialTitleorPosition: | VP OF GOVT PROGRAMS, TENET | ||||||||
| AuthorizedOfficialTelephone: | 3107758043 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 060000152 | CA | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | ZZT40230F (OP) | 05 | CA | MEDICAID | 1039038 | 01 | CIGNA (US / PUERTO RICO) | OTHER | 123050 | 01 | COVENTRY HEALTH CARE KANS | OTHER | 884562490 | 01 | AETNA US HEALTHCARE (NATI | OTHER | 003666-0001 | 01 | PACIFICARE OF CALIFORNIA | OTHER | 8126 | 01 | HEALTH NET | OTHER | HSC30230F (IP) | 05 | CA | MEDICAID | ZZZC3006Z | 01 | BS OF CALIFORNIA | OTHER |