Provider Demographics
NPI:1356511349
Name:INLAND OB/GYN ASSOCIATES, A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:INLAND OB/GYN ASSOCIATES, A MEDICAL CORPORATION
Other - Org Name:WOMEN'S HEALTH CENTER AT ST. BERNARDINE MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCHAUERMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-882-4605
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:909-335-7171
Mailing Address - Fax:909-335-7130
Practice Address - Street 1:7430 CHERRY AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-4255
Practice Address - Country:US
Practice Address - Phone:909-350-4620
Practice Address - Fax:909-854-5920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1528018488Medicaid
CA1356511349Medicaid
CAGR0090610Medicaid
CA1538119318Medicaid
CABJ693YMedicare PIN
CA1356511349Medicaid
CABK362AMedicare PIN
CAGR0090610Medicaid