Provider Demographics
NPI:1427159383
Name:CONTEMPORARY HEALTHCARE MEDICAL GROUP, INC.
Entity type:Organization
Organization Name:CONTEMPORARY HEALTHCARE MEDICAL GROUP, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:ZACHARY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-661-6001
Mailing Address - Street 1:3553 CAMINO MIRA COSTA
Mailing Address - Street 2:#A
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-3512
Mailing Address - Country:US
Mailing Address - Phone:949-661-6001
Mailing Address - Fax:949-661-8353
Practice Address - Street 1:3553 CAMINO MIRA COSTA
Practice Address - Street 2:#A
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-3512
Practice Address - Country:US
Practice Address - Phone:949-661-6001
Practice Address - Fax:949-661-8353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A5020207Q00000X
CAG26491 MCGEE261QP2300X
CAG25398 ZACHARY261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW20A502BMedicare PIN
CAE20277Medicare UPIN
CAW13001Medicare ID - Type Unspecified
CAW13001AMedicare PIN
CAA42650Medicare UPIN
CAA43017Medicare UPIN