Provider Demographics
NPI:1205885357
Name:NEWPORT HARBOR ANESTHESIA CONSULTANTS MEDICAL GROUP INC
Entity type:Organization
Organization Name:NEWPORT HARBOR ANESTHESIA CONSULTANTS MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:CULLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-764-6954
Mailing Address - Street 1:ONE HOAG DRIVE
Mailing Address - Street 2:DEPARTMENT OF ANESTHESIOLOGY
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-4162
Mailing Address - Country:US
Mailing Address - Phone:949-764-6954
Mailing Address - Fax:949-764-5674
Practice Address - Street 1:ONE HOAG DRIVE
Practice Address - Street 2:DEPARTMENT OF ANESTHESIOLOGY
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4162
Practice Address - Country:US
Practice Address - Phone:949-764-6954
Practice Address - Fax:949-764-5674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0084230Medicaid
CAW14312Medicare PIN