Provider Demographics
NPI:1275562902
Name:PACIFIC HEART GROUP INC
Entity Type:Organization
Organization Name:PACIFIC HEART GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:PLOSS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-444-8300
Mailing Address - Street 1:2332 23RD ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-3231
Mailing Address - Country:US
Mailing Address - Phone:707-444-8300
Mailing Address - Fax:707-444-8349
Practice Address - Street 1:2332 23RD ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-3231
Practice Address - Country:US
Practice Address - Phone:707-444-8300
Practice Address - Fax:707-444-8349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Not Answered207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Single Specialty
Not Answered207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Not Answered207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0077000Medicaid
CAA03733Medicare UPIN
CAE75101Medicare UPIN
CAGR0077000Medicaid
CAA31191Medicare UPIN