Provider Demographics
NPI:1467563791
Name:NORTH COUNTY TRAUMA ASSOCIATES, INC. A MEDICAL GROUP
Entity Type:Organization
Organization Name:NORTH COUNTY TRAUMA ASSOCIATES, INC. A MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:T
Authorized Official - Last Name:STEELE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-489-5955
Mailing Address - Street 1:2067 WINERIDGE PLACE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92029-1952
Mailing Address - Country:US
Mailing Address - Phone:760-740-6944
Mailing Address - Fax:760-740-9619
Practice Address - Street 1:215 SOUTH HICKORY AVENUE
Practice Address - Street 2:SUITE 112
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4360
Practice Address - Country:US
Practice Address - Phone:760-489-5955
Practice Address - Fax:760-489-7150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA208600000X, 2086S0102X, 2086S0127X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical CareGroup - Single Specialty
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma SurgeryGroup - Single Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW10717OtherMEDICARE
CAW10717Medicare UPIN