MEDICARE: LONG BEACH SURGERY CENTER, LP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1043217615
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LONG BEACH SURGERY CENTER, LP

Provider Business Mailing Address
First Line	:	20 BURTON HILLS BLVD.
Second Line	:	SUITE 500 ATTN: L&C
City	:	NASHVILLE
State	:	TN
Zip	:	32715-6176
Country	:	US
Telephone Number	:	615-240-3820
Fax Number	:	615-234-1720

Provider Business Practice Location Address
First Line	:	2880 ATLANTIC AVENUE
Second Line	:	SUITE 160
City	:	LONG BEACH
State	:	CA
Zip	:	90806-1715
Country	:	US
Telephone Number	:	562-988-9566
Fax Number	:	562-997-4597

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JEFFREY SNODGRASS
Credential	:
Telephone Number	:	615-665-1283

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	06/27/2022

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