Provider Demographics
NPI:1205006210
Name:NEWPORT SURGICAL, INC.
Entity Type:Organization
Organization Name:NEWPORT SURGICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MCDONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:423-625-1839
Mailing Address - Street 1:890 EDENWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:PARROTTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37843-2554
Mailing Address - Country:US
Mailing Address - Phone:423-625-1839
Mailing Address - Fax:423-625-2083
Practice Address - Street 1:890 EDENWOOD WAY
Practice Address - Street 2:
Practice Address - City:PARROTTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37843
Practice Address - Country:US
Practice Address - Phone:423-625-1839
Practice Address - Fax:423-625-2083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty