Provider Demographics
NPI:1467096644
Name:NEWPORT SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:NEWPORT SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFIE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:HELDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-458-9970
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:
Mailing Address - Fax:
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:949-706-0678
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-31
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty