Provider Demographics
NPI:1992840722
Name:NEWPORT BEACH LIDO SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:NEWPORT BEACH LIDO SURGERY CENTER, LLC
Other - Org Name:HOAG OUTPATIENT SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER, GOVERNING BOARD
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEINBART
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:949-764-8128
Mailing Address - Street 1:351 HOSPITAL RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3509
Mailing Address - Country:US
Mailing Address - Phone:949-642-3263
Mailing Address - Fax:949-642-2034
Practice Address - Street 1:351 HOSPITAL RD
Practice Address - Street 2:SUITE 110
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3509
Practice Address - Country:US
Practice Address - Phone:949-642-3263
Practice Address - Fax:949-642-2034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical