Provider Demographics
NPI:1588709489
Name:FOOTHILL GATEWAY SURGERY CENTER LLC
Entity type:Organization
Organization Name:FOOTHILL GATEWAY SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PATTI
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-305-6336
Mailing Address - Street 1:29300 PORTOLA PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-8718
Mailing Address - Country:US
Mailing Address - Phone:949-305-6336
Mailing Address - Fax:949-767-5764
Practice Address - Street 1:29300 PORTOLA PKWY STE A
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-8718
Practice Address - Country:US
Practice Address - Phone:949-305-6336
Practice Address - Fax:949-767-5764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical