Provider Demographics
NPI:1942447651
Name:MOBILE MEDICAL GROUP
Entity Type:Organization
Organization Name:MOBILE MEDICAL GROUP
Other - Org Name:CALL DOCTOR MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARY
Authorized Official - Middle Name:GRESHAM
Authorized Official - Last Name:BAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-260-6300
Mailing Address - Street 1:5030 CAMINO DE LA SIESTA
Mailing Address - Street 2:SUITE 208
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3116
Mailing Address - Country:US
Mailing Address - Phone:619-260-6300
Mailing Address - Fax:619-260-6313
Practice Address - Street 1:5030 CAMINO DE LA SIESTA
Practice Address - Street 2:SUITE 208
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3116
Practice Address - Country:US
Practice Address - Phone:619-260-6300
Practice Address - Fax:619-260-6313
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOBILE MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-16
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAFAC41617335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0089290Medicaid
CAR059973AMedicare PIN