Provider Demographics
NPI:1437398070
Name:NEWPORT MEDICAL SUPPLY LLC
Entity Type:Organization
Organization Name:NEWPORT MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:U
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-328-3167
Mailing Address - Street 1:PO BOX 3338
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92834-3338
Mailing Address - Country:US
Mailing Address - Phone:714-328-3167
Mailing Address - Fax:714-316-1321
Practice Address - Street 1:3414 W BALL RD STE D
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-3726
Practice Address - Country:US
Practice Address - Phone:714-328-3167
Practice Address - Fax:714-316-1321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-04
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50773332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies