Provider Demographics
NPI:1578697017
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:760-737-2666
Mailing Address - Fax:760-489-2311
Practice Address - Street 1:25485 MEDICAL CENTER DR STE 204
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-6927
Practice Address - Country:US
Practice Address - Phone:951-696-7632
Practice Address - Fax:951-696-3644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR008568Medicaid
CAGR008568Medicaid