Provider Demographics
NPI:1003138736
Name:NEWPORT SURGICAL PARTNERS LLC
Entity Type:Organization
Organization Name:NEWPORT SURGICAL PARTNERS LLC
Other - Org Name:NEWPORT PLAZA SURGICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:HOGUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-706-9900
Mailing Address - Street 1:1901 NEWPORT BLVD
Mailing Address - Street 2:STE 120
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-2278
Mailing Address - Country:US
Mailing Address - Phone:949-515-1040
Mailing Address - Fax:949-650-5796
Practice Address - Street 1:1901 NEWPORT BLVD
Practice Address - Street 2:STE 120
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-2278
Practice Address - Country:US
Practice Address - Phone:949-515-1040
Practice Address - Fax:949-650-5796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-22
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical