Provider Demographics
NPI:1689907040
Name:NORTH COUNTY ENT MEDICAL GROUP
Entity Type:Organization
Organization Name:NORTH COUNTY ENT MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING, CREDENTIALING, CONTRACTING
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-215-1889
Mailing Address - Street 1:521 E ELDER ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92028-3081
Mailing Address - Country:US
Mailing Address - Phone:760-723-1100
Mailing Address - Fax:760-723-2180
Practice Address - Street 1:521 E ELDER ST
Practice Address - Street 2:SUITE 202
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-3081
Practice Address - Country:US
Practice Address - Phone:760-723-1100
Practice Address - Fax:760-723-2180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-16
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & NeckGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP622BMedicare PIN
CACP622AMedicare PIN