Provider Demographics
NPI:1427227735
Name:LANCASTER CARDIOLOGY MEDICAL GROUP INC
Entity Type:Organization
Organization Name:LANCASTER CARDIOLOGY MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:HARI
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANDRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-726-3058
Mailing Address - Street 1:43860 10TH ST W
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-4848
Mailing Address - Country:US
Mailing Address - Phone:661-726-3058
Mailing Address - Fax:661-726-3723
Practice Address - Street 1:1535 N CHINA LAKE BLVD STE B
Practice Address - Street 2:
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-2667
Practice Address - Country:US
Practice Address - Phone:760-446-1699
Practice Address - Fax:661-726-3738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA31143174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ00659ZMedicare PIN
CAW8920Medicare PIN