Provider Demographics
NPI:1700836475
Name:INLAND HEALTHCARE GROUP A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:INLAND HEALTHCARE GROUP A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CAREY
Authorized Official - Middle Name:
Authorized Official - Last Name:PAUL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-335-7171
Mailing Address - Street 1:PO BOX 10488
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92423-0488
Mailing Address - Country:US
Mailing Address - Phone:909-335-7171
Mailing Address - Fax:909-335-7130
Practice Address - Street 1:7291 BOULDER AVE
Practice Address - Street 2:STE 2C
Practice Address - City:HIGHLAND
Practice Address - State:CA
Practice Address - Zip Code:92346-3389
Practice Address - Country:US
Practice Address - Phone:909-862-4226
Practice Address - Fax:909-862-0319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1376594804Medicaid
CA1730390865Medicaid
CA1700836475Medicaid
CA1730390865Medicaid
CA1700836475Medicaid
CA1376594804Medicaid