Provider Demographics
NPI:1497839161
Name:CARDIOVASCULAR PULMONARY MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:CARDIOVASCULAR PULMONARY MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:R
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:MCFADDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD FACC
Authorized Official - Phone:805-967-0497
Mailing Address - Street 1:334 S PATTERSON AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93111
Mailing Address - Country:US
Mailing Address - Phone:805-967-0497
Mailing Address - Fax:805-683-0322
Practice Address - Street 1:334 S PATTERSON AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93111
Practice Address - Country:US
Practice Address - Phone:805-967-0497
Practice Address - Fax:805-683-0322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ48396ZMedicaid
A39492Medicare UPIN
CAW575Medicare ID - Type Unspecified
CAZZZ48396ZMedicaid