Provider Demographics
NPI:1386844439
Name:SAN DIEGO RADIOLOGY MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:SAN DIEGO RADIOLOGY MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:H
Authorized Official - Last Name:CAREY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-565-0950
Mailing Address - Street 1:860 KUHN DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91914-4517
Mailing Address - Country:US
Mailing Address - Phone:619-482-4592
Mailing Address - Fax:619-482-1892
Practice Address - Street 1:860 KUHN DR
Practice Address - Street 2:SUITE 100
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91914-4517
Practice Address - Country:US
Practice Address - Phone:619-482-4592
Practice Address - Fax:619-482-1892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0083815Medicaid
CAHW529AMedicare PIN