Provider Demographics
NPI:1285247569
Name:SURGERY CENTER OF PURE
Entity type:Organization
Organization Name:SURGERY CENTER OF PURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NEDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-706-1469
Mailing Address - Street 1:500 SUPERIOR AVE STE 335
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3681
Mailing Address - Country:US
Mailing Address - Phone:949-706-1469
Mailing Address - Fax:949-706-7307
Practice Address - Street 1:500 SUPERIOR AVE STE 335
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3681
Practice Address - Country:US
Practice Address - Phone:949-706-1469
Practice Address - Fax:949-706-7307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty