Provider Demographics
NPI:1275608937
Name:COMMUNITY MEDICAL GROUP OF RIVERSIDE INC
Entity Type:Organization
Organization Name:COMMUNITY MEDICAL GROUP OF RIVERSIDE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:SWALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-274-3446
Mailing Address - Street 1:4444 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501-4136
Mailing Address - Country:US
Mailing Address - Phone:951-682-5661
Mailing Address - Fax:951-274-3411
Practice Address - Street 1:4444 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-4136
Practice Address - Country:US
Practice Address - Phone:951-682-5661
Practice Address - Fax:951-274-3411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2017-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ75817ZMedicare ID - Type Unspecified