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General NPI Number Information
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NPI Number | 1033803606
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Entity Type | Organization
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Legal Business Name | BAYSIDE SURGERY CENTER LLC
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Dates
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Enumeration Date | 06/06/2023
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Last Update Date | 05/03/2024
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Provider Practice Location Address
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Address Line | 20321 IRVINE AVE STE F2
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-0200
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Country | US
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Telephone | 310-703-7713
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Fax |
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Provider Business Mailing Address
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Address Line | 20321 IRVINE AVE STE F2
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-0200
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Country | US
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Telephone | 310-703-7713
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | JAN ECKERMANN
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Credential | MD
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Telephone | 310-703-7713
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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