Provider Demographics
NPI:1750339479
Name:NEWPORT CARDIAC & THORACIC SURGERY, INC.
Entity type:Organization
Organization Name:NEWPORT CARDIAC & THORACIC SURGERY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:D
Authorized Official - Last Name:CAFFARELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-650-3350
Mailing Address - Street 1:PO BOX 26039
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92799-6039
Mailing Address - Country:US
Mailing Address - Phone:714-263-9106
Mailing Address - Fax:949-650-1274
Practice Address - Street 1:1 HOAG DR BLDG 31
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4162
Practice Address - Country:US
Practice Address - Phone:949-650-3350
Practice Address - Fax:949-650-1274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW10327OtherPTAN
CA0000000135OtherGREATER NEWPORT PHYSICIAN
CAGR002729Medicaid
CAYYY49979YOtherBLUE SHIELD GROUP NUMBER
CAYYY49979YOtherBLUE SHIELD GROUP NUMBER