MEDICARE: WRIGLEY MEDICAL SURGICENTER, LLC

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	:	1750768537
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WRIGLEY MEDICAL SURGICENTER, LLC

Provider Business Mailing Address
First Line	:	2240 PACIFIC AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90806-4372
Country	:	US
Telephone Number	:	562-988-8400
Fax Number	:

Provider Business Practice Location Address
First Line	:	2240 PACIFIC AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90806-4372
Country	:	US
Telephone Number	:	562-988-8400
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. LAI ALBERT
Credential	:	MD
Telephone Number	:	562-988-8400

Provider Enumeration Date	:	04/30/2015
Last Update Date	:	04/30/2015

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