Provider Demographics
NPI:1568495901
Name:WILCARE MEDICARE GROUP, INC.
Entity Type:Organization
Organization Name:WILCARE MEDICARE GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-773-0484
Mailing Address - Street 1:39000 BOB HOPE DR
Mailing Address - Street 2:#P-207
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-3221
Mailing Address - Country:US
Mailing Address - Phone:760-773-0484
Mailing Address - Fax:760-773-9739
Practice Address - Street 1:39000 BOB HOPE DR
Practice Address - Street 2:#P-207
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-3221
Practice Address - Country:US
Practice Address - Phone:760-773-0484
Practice Address - Fax:760-773-9739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG10335207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA080157072OtherRAILROAD MEDICARE
CAZZZ61481ZOtherBLUE SHIELD OF CA
CAZZZ18611ZMedicare PIN