Provider Demographics
NPI:1235111006
Name:PARADISE MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:PARADISE MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:THORP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-872-6650
Mailing Address - Street 1:6470 PENTZ RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95969-3674
Mailing Address - Country:US
Mailing Address - Phone:530-872-6650
Mailing Address - Fax:530-872-6653
Practice Address - Street 1:6470 PENTZ RD
Practice Address - Street 2:SUITE A
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-3674
Practice Address - Country:US
Practice Address - Phone:530-872-6650
Practice Address - Fax:530-872-6653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-17
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ21920ZOtherBLUE SHIELD
CAZZZ29821ZMedicare ID - Type Unspecified
CAZZZ22121ZMedicare ID - Type Unspecified
CAZZZ21341ZMedicare ID - Type Unspecified
CAZZZ21350ZMedicare ID - Type Unspecified
CAZZZ21920ZOtherBLUE SHIELD
CAZZZ21342ZMedicare ID - Type Unspecified
CAZZZ21344ZMedicare ID - Type Unspecified