Provider Demographics
NPI:1164467205
Name:LIN & WILSON RADIOLOGY MEDICAL GROUP INC
Entity Type:Organization
Organization Name:LIN & WILSON RADIOLOGY MEDICAL GROUP INC
Other - Org Name:PLAZA MEDICAL IMAGING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:S
Authorized Official - Last Name:LIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-744-6108
Mailing Address - Street 1:3731 S PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-7463
Mailing Address - Country:US
Mailing Address - Phone:714-918-0478
Mailing Address - Fax:
Practice Address - Street 1:3731 S PLAZA DR
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-7463
Practice Address - Country:US
Practice Address - Phone:714-918-0478
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAREG. # 63463261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HW14Z05AMedicare PIN
HW14205CMedicare PIN
HW14205DMedicare PIN
CAHW14205Medicare ID - Type UnspecifiedMEDICARE ID
F01048Medicare UPIN