MEDICARE: ORANGE COAST SURGICAL CENTER, INC

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	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1598791923
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORANGE COAST SURGICAL CENTER, INC

Provider Business Mailing Address
First Line	:	240 NEWPORT CENTER DR
Second Line	:	# 105
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-7512
Country	:	US
Telephone Number	:	949-644-2450
Fax Number	:	949-644-2451

Provider Business Practice Location Address
First Line	:	240 NEWPORT CENTER DR
Second Line	:	# 105
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-7512
Country	:	US
Telephone Number	:	949-644-2450
Fax Number	:	949-644-2451

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. BRADLEY PIERCE MUDGE
Credential	:	M.D.
Telephone Number	:	949-644-2450

Provider Enumeration Date	:	06/25/2006
Last Update Date	:	06/15/2010

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