Provider Demographics
NPI:1285664466
Name:NEWPORT MULTI SPECIALTY SURGERY CENTER LLC
Entity Type:Organization
Organization Name:NEWPORT MULTI SPECIALTY SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:H.
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:BRENNAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-355-1284
Mailing Address - Street 1:400 NEWPORT CENTER DR STE 102
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-8602
Mailing Address - Country:US
Mailing Address - Phone:949-423-2170
Mailing Address - Fax:949-606-8618
Practice Address - Street 1:400 NEWPORT CENTER DR STE 102
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-8602
Practice Address - Country:US
Practice Address - Phone:949-423-2170
Practice Address - Fax:949-606-8618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS051631Medicare ID - Type Unspecified