Provider Demographics
NPI:1457803157
Name:JOHN CARLISLE BROWN, MC, INC
Entity Type:Organization
Organization Name:JOHN CARLISLE BROWN, MC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:PLUIMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-645-9766
Mailing Address - Street 1:3900 W COAST HWY STE 300
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-4093
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3900 W COAST HWY STE 300
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4093
Practice Address - Country:US
Practice Address - Phone:949-645-9766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-28
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG14693275N00000X, 284300000X, 305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
No275N00000XHospital UnitsMedicare Defined Swing Bed Unit
No284300000XHospitalsSpecial Hospital