Provider Demographics
NPI:1629198742
Name:OSF MEDICAL GROUP OF CALIFORNIA, INC
Entity Type:Organization
Organization Name:OSF MEDICAL GROUP OF CALIFORNIA, INC
Other - Org Name:SPINE AND ORTHOPEDIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:MOELLEKEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-563-3307
Mailing Address - Street 1:PO BOX 3559
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93403-3559
Mailing Address - Country:US
Mailing Address - Phone:805-786-4879
Mailing Address - Fax:805-597-8354
Practice Address - Street 1:401 E CARRILLO ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-1460
Practice Address - Country:US
Practice Address - Phone:805-563-3307
Practice Address - Fax:805-563-3827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1304080001Medicare NSC
CAW15176Medicare PIN