MEDICARE: HOAG MEDICAL GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1235517806
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOAG MEDICAL GROUP

Provider Business Mailing Address
First Line	:	13 HELMCREST
Second Line	:
City	:	ALISO VIEJO
State	:	CA
Zip	:	92656-1924
Country	:	US
Telephone Number	:	949-280-4879
Fax Number	:

Provider Business Practice Location Address
First Line	:	26522 LA ALAMEDA STE 120
Second Line	:
City	:	MISSION VIEJO
State	:	CA
Zip	:	92691-6330
Country	:	US
Telephone Number	:	949-282-1618
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF CLINICAL OPERATIONS
Name	:	SUZI COOPER
Credential	:	NP
Telephone Number	:	949-282-1618

Provider Enumeration Date	:	05/14/2015
Last Update Date	:	05/14/2015

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