Provider Demographics
NPI:1619943537
Name:HEMET RADIOLOGY MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:HEMET RADIOLOGY MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR / PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:951-765-5417
Mailing Address - Street 1:235 LAURSEN ST
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-4437
Mailing Address - Country:US
Mailing Address - Phone:951-765-5417
Mailing Address - Fax:951-765-5418
Practice Address - Street 1:1117 E DEVONSHIRE AVE
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-3083
Practice Address - Country:US
Practice Address - Phone:951-652-2811
Practice Address - Fax:951-765-4986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-28
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0051940Medicaid
CACH1170OtherRAILROAD MEDICARE
CAGR0051943Medicaid
CAGR0051944Medicaid
CACU0238OtherRAILROAD MEDICARE
CAGR0051941Medicaid
CAGR0051942Medicaid
CACH1170OtherRAILROAD MEDICARE
CAGR0051943Medicaid
CAHW14273Medicare PIN
CACU0238OtherRAILROAD MEDICARE
CAZZZ26168ZMedicare PIN