Provider Demographics
NPI:1992094924
Name:JAMES C. PINE MD A MEDICAL CORPORATION
Entity type:Organization
Organization Name:JAMES C. PINE MD A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:PINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-360-4888
Mailing Address - Street 1:76624 PANSY CIR
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-7454
Mailing Address - Country:US
Mailing Address - Phone:760-360-4888
Mailing Address - Fax:760-200-4321
Practice Address - Street 1:76624 PANSY CIR
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-7454
Practice Address - Country:US
Practice Address - Phone:760-360-4888
Practice Address - Fax:760-200-4321
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JAMES C. PINE MD, A MEDICAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-30
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC25244207R00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing FacilityGroup - Single Specialty