Provider Demographics
NPI:1376693994
Name:ORANGE COAST UROLOGY SURG MED GRP INC
Entity Type:Organization
Organization Name:ORANGE COAST UROLOGY SURG MED GRP INC
Other - Org Name:ORANGE COAST UROLGOY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JUDI
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-646-1131
Mailing Address - Street 1:520 SUPERIOR AVE
Mailing Address - Street 2:SUITE 240
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3637
Mailing Address - Country:US
Mailing Address - Phone:949-646-1131
Mailing Address - Fax:
Practice Address - Street 1:520 SUPERIOR AVE
Practice Address - Street 2:SUITE 240
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3637
Practice Address - Country:US
Practice Address - Phone:949-646-1131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric UrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF38980Medicare UPIN
CAW1321BMedicare PIN
CAH87294Medicare UPIN
CAF22680Medicare UPIN