Provider Demographics
NPI:1942229885
Name:HILLCREST SURGICAL MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:HILLCREST SURGICAL MEDICAL GROUP, INC.
Other - Org Name:PACIFIC BARIATRIC SURGICAL MEDICAL GROUP, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SURGEON PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:WILLIAMS
Authorized Official - Last Name:RUMSEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:619-298-9931
Mailing Address - Street 1:4060 FOURTH AVENUE
Mailing Address - Street 2:SUITE 330
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103
Mailing Address - Country:US
Mailing Address - Phone:619-298-9931
Mailing Address - Fax:619-298-3613
Practice Address - Street 1:4060 FOURTH AVENUE
Practice Address - Street 2:SUITE 330
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103
Practice Address - Country:US
Practice Address - Phone:619-298-9931
Practice Address - Fax:619-298-3613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG40645174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ83350ZMedicaid
CAW4910Medicare ID - Type Unspecified
CAZZZ83350ZMedicaid