Provider Demographics
NPI:1568762540
Name:SHARP REES-STEALY MEDICAL GROUP INC
Entity Type:Organization
Organization Name:SHARP REES-STEALY MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-262-6666
Mailing Address - Street 1:PO BOX 939087
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92193-9087
Mailing Address - Country:US
Mailing Address - Phone:858-262-6344
Mailing Address - Fax:858-636-2032
Practice Address - Street 1:8881 FLETCHER PKWY
Practice Address - Street 2:SUITE 105
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942
Practice Address - Country:US
Practice Address - Phone:619-446-1646
Practice Address - Fax:858-636-2032
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHARP REES-STEALY MEDICAL GROUP, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-10-25
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW216Medicare PIN
CA6493130007Medicare NSC