Provider Demographics
NPI:1306993464
Name:PACIFIC HILLS SURGERY CENTER LLC
Entity type:Organization
Organization Name:PACIFIC HILLS SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMIN OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:CUNNIFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-543-1874
Mailing Address - Street 1:24022 CALLE DE LA PLATA
Mailing Address - Street 2:#180
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-3627
Mailing Address - Country:US
Mailing Address - Phone:949-458-3551
Mailing Address - Fax:949-951-9478
Practice Address - Street 1:24022 CALLE DE LA PLATA
Practice Address - Street 2:#180
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3627
Practice Address - Country:US
Practice Address - Phone:949-458-3551
Practice Address - Fax:949-206-1179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS051009Medicare PIN