Provider Demographics
NPI:1811273576
Name:CMG MEDICAL GROUP INC
Entity type:Organization
Organization Name:CMG MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:B
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-543-4043
Mailing Address - Street 1:1555 HIGUERA STREET
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBSIPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-2917
Mailing Address - Country:US
Mailing Address - Phone:805-543-4043
Mailing Address - Fax:
Practice Address - Street 1:265 POSADA LANE
Practice Address - Street 2:SUITE B
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-4056
Practice Address - Country:US
Practice Address - Phone:805-434-0900
Practice Address - Fax:805-434-9260
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CMG MEDICAL GROUP INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG51256207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty