Provider Demographics
NPI:1811986268
Name:NEWPORT HEART MEDICAL GROUP INC
Entity type:Organization
Organization Name:NEWPORT HEART MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-548-9611
Mailing Address - Street 1:415 OLD NEWPORT BLVD
Mailing Address - Street 2:# 200
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663
Mailing Address - Country:US
Mailing Address - Phone:949-548-9611
Mailing Address - Fax:949-548-9958
Practice Address - Street 1:415 OLD NEWPORT BLVD
Practice Address - Street 2:# 200
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663
Practice Address - Country:US
Practice Address - Phone:949-548-9611
Practice Address - Fax:949-548-9958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
CA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB09070412OtherDEA #
CAB09070412OtherDEA #
CAC18356Medicare UPIN
CAF51023Medicare UPIN
CAE25267Medicare UPIN
CAA92293Medicare UPIN