Provider Demographics
NPI:1043425242
Name:LOMPOC ORTHOPEDIC MEDICAL CLINIC
Entity Type:Organization
Organization Name:LOMPOC ORTHOPEDIC MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CAM
Authorized Official - Middle Name:E
Authorized Official - Last Name:LINDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-735-3434
Mailing Address - Street 1:PO BOX 415
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93438-0415
Mailing Address - Country:US
Mailing Address - Phone:805-735-3434
Mailing Address - Fax:805-737-9585
Practice Address - Street 1:1111 E OCEAN AVE
Practice Address - Street 2:STE 1
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-2500
Practice Address - Country:US
Practice Address - Phone:805-735-3434
Practice Address - Fax:805-737-9585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA24846207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A248460Medicaid
CA0302820001Medicare NSC
CAWA24846BMedicare ID - Type Unspecified
CA00A248460Medicaid