=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528261195
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ORCHARD CREEK SURGERY CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/08/2007
-----------------------------------------------------
Last Update Date | 03/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 525 SOUTH DR STE 115
-----------------------------------------------------
City | MOUNTAIN VIEW
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94040-4211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-969-5600
-----------------------------------------------------
Fax | 650-969-0360
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 301 HIGH ST
-----------------------------------------------------
City | PALO ALTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94301-1043
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-969-5600
-----------------------------------------------------
Fax | 650-969-0360
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | GREG MORGANROTH
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 650-969-5600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number | G81771
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------