Basic Information
| Provider Information | |||||||||
| NPI: | 1730466483 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HOAG OUTPATIENT CENTERS, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | HOAG ENDOSCOPY CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 HOAG DR | ||||||||
| Address2: | PO BOX 6100 | ||||||||
| City: | NEWPORT BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926634162 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9497644624 | ||||||||
| FaxNumber: | 9497645746 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 SUPERIOR AVE | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | NEWPORT BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926633657 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9497647580 | ||||||||
| FaxNumber: | 9497647585 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2011 | ||||||||
| LastUpdateDate: | 11/09/2011 | ||||||||
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| AuthorizedOfficialLastName: | BRAITHWAITE | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | T | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 9495173141 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | HOAG MEMORIAL HOSPITAL PRESBYTERIAN | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.