Provider Demographics
NPI:1396063079
Name:CENTRAL COAST RADIOLOGY MEDICAL GROUP INC
Entity type:Organization
Organization Name:CENTRAL COAST RADIOLOGY MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:POOLE
Authorized Official - Last Name:CARTLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-434-1491
Mailing Address - Street 1:PO BOX 218
Mailing Address - Street 2:262 POSADA LANE SUITE C
Mailing Address - City:TEMPLETON
Mailing Address - State:CA
Mailing Address - Zip Code:93465-0218
Mailing Address - Country:US
Mailing Address - Phone:805-434-1491
Mailing Address - Fax:805-434-4997
Practice Address - Street 1:1100 LAS TABLAS RD
Practice Address - Street 2:
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-9704
Practice Address - Country:US
Practice Address - Phone:805-434-1491
Practice Address - Fax:805-434-4997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-05
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA470356702085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADL294AMedicare PIN