Provider Demographics
NPI:1255411781
Name:R.C. AGNEW, M.D., OB GYN MEDICAL CORPORATION
Entity type:Organization
Organization Name:R.C. AGNEW, M.D., OB GYN MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:COURTNEY
Authorized Official - Last Name:AGNEW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-650-3777
Mailing Address - Street 1:351 HOSPITAL RD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3509
Mailing Address - Country:US
Mailing Address - Phone:949-650-3777
Mailing Address - Fax:949-650-0126
Practice Address - Street 1:351 HOSPITAL RD
Practice Address - Street 2:SUITE 306
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3509
Practice Address - Country:US
Practice Address - Phone:949-650-3777
Practice Address - Fax:949-650-0126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC28577174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA87277Medicare UPIN