Provider Demographics
NPI:1528238961
Name:INLAND HEALTHCARE GROUP, A MEDICAL CORPORATION
Entity type:Organization
Organization Name:INLAND HEALTHCARE GROUP, A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CAREY
Authorized Official - Middle Name:
Authorized Official - Last Name:PAUL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-335-7171
Mailing Address - Street 1:PO BOX 10488
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92423-0488
Mailing Address - Country:US
Mailing Address - Phone:909-335-7171
Mailing Address - Fax:909-335-7139
Practice Address - Street 1:2150 N WATERMAN AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-4811
Practice Address - Country:US
Practice Address - Phone:909-886-4971
Practice Address - Fax:909-883-0459
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INLAND HEALTHCARE GROUP, A MEDICAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-29
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1235351206Medicaid
CA1528238961Medicaid
CA1497965529Medicaid
CAZZZ70178ZOtherBS/TRIWEST
CADL050ZMedicare PIN
CA1497965529Medicaid
CABJ854Medicare PIN