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General NPI Number Information
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NPI Number | 1598791923
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Entity Type | Organization
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Legal Business Name | ORANGE COAST SURGICAL CENTER, INC
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Dates
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Enumeration Date | 06/25/2006
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Last Update Date | 06/15/2010
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Provider Practice Location Address
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Address Line | 240 NEWPORT CENTER DR # 105
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-7512
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Country | US
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Telephone | 949-644-2450
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Fax | 949-644-2451
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Provider Business Mailing Address
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Address Line | 240 NEWPORT CENTER DR # 105
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-7512
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Country | US
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Telephone | 949-644-2450
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Fax | 949-644-2451
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. BRADLEY PIERCE MUDGE
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Credential | M.D.
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Telephone | 949-644-2450
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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