Provider Demographics
NPI:1306871306
Name:MEDICAL GROUP OF NORTH COUNTY, INC.
Entity type:Organization
Organization Name:MEDICAL GROUP OF NORTH COUNTY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO/CFO
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:L
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-598-1700
Mailing Address - Street 1:910 SYCAMORE AVE
Mailing Address - Street 2:SUITE 270
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92081-7832
Mailing Address - Country:US
Mailing Address - Phone:760-598-1700
Mailing Address - Fax:760-598-1196
Practice Address - Street 1:910 SYCAMORE AVE
Practice Address - Street 2:SUITE 270
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-7832
Practice Address - Country:US
Practice Address - Phone:760-598-1700
Practice Address - Fax:760-598-1196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACS9824OtherRAILROAD MEDICARE
CAGR0051600Medicaid
CALAB24971FMedicaid
CAZZZ32969ZOtherBLUE SHIELD
CALAB24971FMedicaid
CACS9824OtherRAILROAD MEDICARE