Provider Demographics
NPI:1891741831
Name:PHYSICIANS RADIOLOGY MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:PHYSICIANS RADIOLOGY MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-229-6551
Mailing Address - Street 1:8400 MIRAMAR RD
Mailing Address - Street 2:200
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-4387
Mailing Address - Country:US
Mailing Address - Phone:858-564-1400
Mailing Address - Fax:858-564-1500
Practice Address - Street 1:6386 ALVARADO CT
Practice Address - Street 2:121
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-4905
Practice Address - Country:US
Practice Address - Phone:619-229-6551
Practice Address - Fax:619-286-4524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ35437ZOtherBLUE SHIELD
CAZZZ80428ZMedicaid
ZZZ35440ZOtherBLUE SHIELD
CAZZZ80191ZMedicaid
CAW3314AMedicare PIN
CAZZZ80191ZMedicaid
CACR0315Medicare PIN