Organization
ORTHOPEDIC SURGERY CENTER OF OC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RUSSELL PETRIE M.D. (CHAIRMAN)
(949) 782-5038
Entity
Organization
Contact information
Practice address
22 CORPORATE PLAZA, #150, NEWPORT BEACH, CA 92660
(949) 515-0708
(949) 515-4821
Mailing address
22 CORPORATE PLAZA #150, NEWPORT BEACH, CA 92660
(949) 515-0708
(949) 515-4821
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
060000520
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
051445
BLUE CROSS
CA
01
—
ZZZ60061Z
BLUE SHIELD
CA
Enumeration date
05/23/2005
Last updated
09/25/2023
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