Provider Demographics
NPI:1891939351
Name:SOUTH COAST MEDICAL CENTER FOR NEW MEDICINE,.INC
Entity Type:Organization
Organization Name:SOUTH COAST MEDICAL CENTER FOR NEW MEDICINE,.INC
Other - Org Name:CENTER FOR NEW MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEIGH
Authorized Official - Middle Name:ERIN
Authorized Official - Last Name:CONNEALY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-680-1880
Mailing Address - Street 1:6 HUGHES
Mailing Address - Street 2:SUITE 100
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2059
Mailing Address - Country:US
Mailing Address - Phone:949-680-1880
Mailing Address - Fax:949-680-1919
Practice Address - Street 1:6 HUGHES
Practice Address - Street 2:SUITE 100
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-2059
Practice Address - Country:US
Practice Address - Phone:949-680-1880
Practice Address - Fax:949-680-1919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-28
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A11028111N00000X
CAG57433208D00000X
CARHF75256247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFA325AOtherMEDICARE PTAN