Provider Demographics
NPI:1134164460
Name:QUALITYCARE MEDICAL CENTER INC.
Entity type:Organization
Organization Name:QUALITYCARE MEDICAL CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF PROCESSING OFFICER, INSURANCE
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:L
Authorized Official - Last Name:MUTSCHLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-630-2422
Mailing Address - Street 1:840 TOWNSITE DRIVE
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084
Mailing Address - Country:US
Mailing Address - Phone:760-630-2422
Mailing Address - Fax:760-630-3771
Practice Address - Street 1:840 TOWNSITE DRIVE
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084
Practice Address - Country:US
Practice Address - Phone:760-630-2422
Practice Address - Fax:760-630-3771
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:QUALITYCARE MEDICAL CENTER INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-19
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37015174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW1117OtherPTAN
CAW1117OtherPTAN