Provider Demographics
NPI:1033685441
Name:NEWPORT BALBOA SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:NEWPORT BALBOA SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCGINLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-637-3600
Mailing Address - Street 1:20360 SW BIRCH ST STE 210
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-1534
Mailing Address - Country:US
Mailing Address - Phone:858-967-9343
Mailing Address - Fax:
Practice Address - Street 1:20360 SW BIRCH ST STE 210
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-1534
Practice Address - Country:US
Practice Address - Phone:858-967-9343
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-23
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0006XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Fertility Facility