1205076593 NPI number — HEALTHCARE PARTNERS ASC-HB, LLC

Table of content: (NPI 1205076593)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205076593 NPI number — HEALTHCARE PARTNERS ASC-HB, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTHCARE PARTNERS ASC-HB, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
TALBERT SURGICAL ASSOCIATES, LLC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205076593
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/20/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 6400
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TORRANCE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90504-6400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-525-3868
Provider Business Mailing Address Fax Number:
310-783-5581

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7677 CENTER STREET
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
HUNTINGTON BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92647-3030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-881-8700
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/25/2009

Additional Information

Authorized Official

Authorized Official Last Name:
LIETHEN
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
G.
Authorized Official Title or Position:
SECRETARY
Authorized Official Telephone Number:
952-205-6262

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  A272769 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: A272769 . This is a "BUSINEE LICENSE #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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