Provider Demographics
NPI:1639624992
Name:BEAVER MEDICAL GROUP
Entity Type:Organization
Organization Name:BEAVER MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR FOR BMG
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:JIH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-335-4129
Mailing Address - Street 1:25815 SUNRISE WAY
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3847
Mailing Address - Country:US
Mailing Address - Phone:423-785-7151
Mailing Address - Fax:
Practice Address - Street 1:25815 SUNRISE WAY
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3847
Practice Address - Country:US
Practice Address - Phone:423-785-7151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-16
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty