Provider Demographics
NPI:1184221137
Name:NEWPORT SUPERIOR MEDICAL & INFUSION INC
Entity Type:Organization
Organization Name:NEWPORT SUPERIOR MEDICAL & INFUSION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF INTAKE
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:STOUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-601-6001
Mailing Address - Street 1:1501 SUPERIOR AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3640
Mailing Address - Country:US
Mailing Address - Phone:949-484-4100
Mailing Address - Fax:866-542-8631
Practice Address - Street 1:1501 SUPERIOR AVE STE 202
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3640
Practice Address - Country:US
Practice Address - Phone:949-484-4100
Practice Address - Fax:866-542-8631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-02
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA193200000XOtherTAXONOMY