Provider Demographics
NPI:1336229822
Name:GASTROENTEROLOGY ALLIANCE OF NEWPORT, A MEDICAL PARTNERSHIP
Entity Type:Organization
Organization Name:GASTROENTEROLOGY ALLIANCE OF NEWPORT, A MEDICAL PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:G
Authorized Official - Last Name:QUIST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-650-8700
Mailing Address - Street 1:361 HOSPITAL RD
Mailing Address - Street 2:STE 331
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3522
Mailing Address - Country:US
Mailing Address - Phone:949-650-8700
Mailing Address - Fax:949-650-0877
Practice Address - Street 1:361 HOSPITAL RD
Practice Address - Street 2:STE 331
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3522
Practice Address - Country:US
Practice Address - Phone:949-650-8700
Practice Address - Fax:949-650-0877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG42979207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0079860Medicaid
CAA49180Medicare UPIN
CAW15325Medicare ID - Type Unspecified