1235309428 NPI number — INLAND HEALTHCARE GROUP, A MEDICAL CORPORATION

Table of content: LAUREN SCELSA PA-C (NPI 1093254856)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235309428 NPI number — INLAND HEALTHCARE GROUP, A MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INLAND HEALTHCARE GROUP, A MEDICAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235309428
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/24/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 10488
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN BERNARDINO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92423-0488
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-344-9111
Provider Business Mailing Address Fax Number:
909-335-7130

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1033 N WATERMAN AVE
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
SAN BERNARDINO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92410-3823
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-383-9385
Provider Business Practice Location Address Fax Number:
909-383-4009
Provider Enumeration Date:
03/04/2008

Additional Information

Authorized Official

Authorized Official Last Name:
PAUL
Authorized Official First Name:
CAREY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
909-335-7171

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1376593889 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1235309428 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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