Provider Demographics
NPI:1285838425
Name:NEWPORT CENTRE OUTPATIENT SURGERY FACILITIES, INC.
Entity Type:Organization
Organization Name:NEWPORT CENTRE OUTPATIENT SURGERY FACILITIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:V
Authorized Official - Last Name:ELAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-721-1113
Mailing Address - Street 1:360 SAN MIGUEL DR STE 207
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7820
Mailing Address - Country:US
Mailing Address - Phone:949-721-1113
Mailing Address - Fax:
Practice Address - Street 1:360 SAN MIGUEL DR STE 207
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7820
Practice Address - Country:US
Practice Address - Phone:949-721-1113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC38533261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC38533OtherSTATE LICENSE NO.