1295234789 NPI number — M HUGH BAILEY MD FACS PC INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295234789 NPI number — M HUGH BAILEY MD FACS PC INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
M HUGH BAILEY MD FACS PC INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295234789
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/17/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
351 HOSPITAL RD STE 617
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWPORT BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92663-3508
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-650-6710
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
351 HOSPITAL RD STE 617
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWPORT BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92663-3508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-650-6710
Provider Business Practice Location Address Fax Number:
949-650-6713
Provider Enumeration Date:
02/09/2018

Additional Information

Authorized Official

Authorized Official Last Name:
BAILEY
Authorized Official First Name:
MARTIN
Authorized Official Middle Name:
HUGH
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
949-650-6710

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X , with the licence number:  A48435 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: A48435 . This is a "MEDICAL BOARD OF CALIFORNIA LICENSE NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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