Provider Demographics
NPI:1306988381
Name:SANTA CRUZ RADIATION ONCOLOGY MEDICAL GROUP, INCORPORATED
Entity type:Organization
Organization Name:SANTA CRUZ RADIATION ONCOLOGY MEDICAL GROUP, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MEISEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:831-462-3050
Mailing Address - Street 1:1575 SOQUEL DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95065-1700
Mailing Address - Country:US
Mailing Address - Phone:831-462-3050
Mailing Address - Fax:831-462-6068
Practice Address - Street 1:1575 SOQUEL DR
Practice Address - Street 2:SUITE 100
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95065-1700
Practice Address - Country:US
Practice Address - Phone:831-462-3050
Practice Address - Fax:831-462-6068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADF7086OtherMEDICARE RR
CAGR0007340Medicaid
ZZZ04913ZMedicare PIN