Provider Demographics
NPI:1922061779
Name:NEWPORT EMERGENCY MEDICAL GROUP INC
Entity Type:Organization
Organization Name:NEWPORT EMERGENCY MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:RICCI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-751-4664
Mailing Address - Street 1:PO BOX 720300
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73172-0300
Mailing Address - Country:US
Mailing Address - Phone:405-751-4664
Mailing Address - Fax:405-749-4561
Practice Address - Street 1:1 HOAG DR
Practice Address - Street 2:ECU DEPT.
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4162
Practice Address - Country:US
Practice Address - Phone:949-764-5689
Practice Address - Fax:405-749-4561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-11
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0078110Medicaid
CA199402800OtherDEPT. OF LABOR
CAZZZ535282OtherBLUE SHIELD
CACG0582Medicare PIN
CA199402800OtherDEPT. OF LABOR