Long Beach Surgical Group a Medical Corporation

Primary specialty

SpecialistTaxonomy code 174400000X

License

C25484 Issued in CA

Legal business name

LONG BEACH SURGICAL GROUP A MEDICAL CORPORATION

Practice address

1040 Elm Ave
Suite #303
Long Beach, CA 90813-3264

Phone

(562) 436-9645

Fax

(562) 436-7119

NPI assigned

Nov 27, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Linda Rose

Title

Office Manager

Phone

(562) 436-9645

Specialties & licenses 1

Addresses

Other identifiers 2

Networks

• BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1196121600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1349395200000",
    "number": "1073795498",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1040 ELM AVE",
            "address_2": "SUITE #303",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908133264",
            "telephone_number": "562-436-9645",
            "fax_number": "562-436-7119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1040 ELM AVE",
            "address_2": "SUITE #303",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908133264",
            "telephone_number": "562-436-9645",
            "fax_number": "562-436-7119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONG BEACH SURGICAL GROUP A MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-27",
        "last_updated": "2012-10-05",
        "status": "A",
        "authorized_official_last_name": "ROSE",
        "authorized_official_first_name": "LINDA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "562-436-9645",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "C25484",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00C254840",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0014610",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Long Beach Sleep Institute
• Long Beach Spine & Rehabilitation
• Long Beach Spine & Rehabilitation Chiropractic Health Center
• Long Beach Spring Family Medical GRP
• Long Beach Surgery Center, LP
• Long Beach Surgical Institute
• Long Beach Surgicare LLC
• Long Beach Total Body Therapy Inc
• Long Beach Unified School District
• Long Beach VA

• Specialist in Long Beach, CA
• Providers in Long Beach, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.