Provider Demographics
NPI:1730349960
Name:UNIVERSITY OF CALIFORNIA IRVINE
Entity type:Organization
Organization Name:UNIVERSITY OF CALIFORNIA IRVINE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REIMBURSEMENT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHURCHILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-509-6266
Mailing Address - Street 1:1500 S DOUGLASS BLVD, #200 RT 183
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92806
Mailing Address - Country:US
Mailing Address - Phone:714-509-6266
Mailing Address - Fax:
Practice Address - Street 1:800 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-3576
Practice Address - Country:US
Practice Address - Phone:714-456-3006
Practice Address - Fax:714-456-3961
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UCI MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-11
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA060000148261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA551965Medicare Oscar/Certification