Provider Demographics
NPI:1598763971
Name:RADIATION MEDICAL GROUP INC
Entity Type:Organization
Organization Name:RADIATION MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:G
Authorized Official - Last Name:MYKING
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:858-888-7700
Mailing Address - Street 1:PO BOX 33865
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92163-3865
Mailing Address - Country:US
Mailing Address - Phone:858-888-7700
Mailing Address - Fax:858-888-7721
Practice Address - Street 1:701 E GRAND AVE
Practice Address - Street 2:STE 200
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4404
Practice Address - Country:US
Practice Address - Phone:760-839-7370
Practice Address - Fax:858-888-7758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-11
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0062073Medicaid
CAW17952Medicare UPIN
CAW13257DMedicare ID - Type Unspecified
CAGR0062073Medicaid