Provider Demographics
NPI:1235309428
Name:INLAND HEALTHCARE GROUP, A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:INLAND HEALTHCARE GROUP, A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CAREY
Authorized Official - Middle Name:
Authorized Official - Last Name:PAUL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-335-7171
Mailing Address - Street 1:PO BOX 10488
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92423-0488
Mailing Address - Country:US
Mailing Address - Phone:888-344-9111
Mailing Address - Fax:909-335-7130
Practice Address - Street 1:1033 N WATERMAN AVE
Practice Address - Street 2:SUITE E
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92410-3823
Practice Address - Country:US
Practice Address - Phone:909-383-9385
Practice Address - Fax:909-383-4009
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INLAND HEALTHCARE GROUP, A MEDICAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-04
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1376593889Medicaid
CA1235309428Medicaid
CA1235309428Medicaid
CA1376593889Medicaid