Provider Demographics
NPI:1619576824
Name:SURGICARE OF LA VETA, LTD.
Entity Type:Organization
Organization Name:SURGICARE OF LA VETA, LTD.
Other - Org Name:NEWPORT COAST SURGICAL INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGINLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-637-3600
Mailing Address - Street 1:20360 SW BIRCH ST STE 110
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-1532
Mailing Address - Country:US
Mailing Address - Phone:949-833-1432
Mailing Address - Fax:
Practice Address - Street 1:20360 SW BIRCH ST STE 110
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-1532
Practice Address - Country:US
Practice Address - Phone:949-833-1432
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SURGICARE OF LA VETA, LTD.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-10-19
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical