Provider Demographics
NPI:1598791923
Name:ORANGE COAST SURGICAL CENTER, INC
Entity Type:Organization
Organization Name:ORANGE COAST SURGICAL CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:PIERCE
Authorized Official - Last Name:MUDGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-644-2450
Mailing Address - Street 1:240 NEWPORT CENTER DR
Mailing Address - Street 2:# 105
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7512
Mailing Address - Country:US
Mailing Address - Phone:949-644-2450
Mailing Address - Fax:949-644-2451
Practice Address - Street 1:240 NEWPORT CENTER DR
Practice Address - Street 2:# 105
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7512
Practice Address - Country:US
Practice Address - Phone:949-644-2450
Practice Address - Fax:949-644-2451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS051793Medicare PIN