Provider Demographics
NPI:1437282696
Name:SOUTHWEST HEMATOLOGY ONCOLOGY MEDICAL GROUP
Entity Type:Organization
Organization Name:SOUTHWEST HEMATOLOGY ONCOLOGY MEDICAL GROUP
Other - Org Name:SOUTHWEST CANCER CARE MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE MANAGAER
Authorized Official - Prefix:
Authorized Official - First Name:PAT
Authorized Official - Middle Name:A
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-737-2666
Mailing Address - Street 1:701 E GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-4466
Mailing Address - Country:US
Mailing Address - Phone:858-451-7066
Mailing Address - Fax:858-487-8308
Practice Address - Street 1:15725 POMERADO RD
Practice Address - Street 2:STE 206
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2068
Practice Address - Country:US
Practice Address - Phone:760-737-2666
Practice Address - Fax:760-489-2311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG4008568Medicare ID - Type UnspecifiedMEDI-CAL GROUP NUMBER
CAZZZ15700ZMedicare ID - Type UnspecifiedMEDICARE NORTH
CAW4957Medicare ID - Type UnspecifiedMEDICARE SOUTH