Provider Demographics
NPI:1073853180
Name:SCRIPPS CLINIC MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:SCRIPPS CLINIC MEDICAL GROUP, INC
Other - Org Name:SCRIPPS PROTON THERAPY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:MULVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-554-8500
Mailing Address - Street 1:9730 SUMMERS RIDGE RD
Mailing Address - Street 2:PTC-100
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-3101
Mailing Address - Country:US
Mailing Address - Phone:858-549-7400
Mailing Address - Fax:
Practice Address - Street 1:9730 SUMMERS RIDGE RD
Practice Address - Street 2:PTC-100
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-3101
Practice Address - Country:US
Practice Address - Phone:858-549-7400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-26
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG663522085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty