| Cassidy Medical Group Inc. | |
|
145 Thunder Dr Vista CA 92083-6010 | |
| (760) 630-5487 | |
| (760) 630-2558 |
| Full Name | Cassidy Medical Group Inc. |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 145 Thunder Dr, Vista, California |
| Authorized Official Name and Position | John M Bennett (PRESIDENT) |
| Authorized Official Contact | 7606305487 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Cassidy Medical Group Inc. 145 Thunder Dr Vista CA 92083-6010 Ph: (760) 630-5487 | Cassidy Medical Group Inc. 145 Thunder Dr Vista CA 92083-6010 Ph: (760) 630-5487 |
| NPI Number | 1215003470 |
|---|---|
| Provider Enumeration Date | 11/28/2006 |
| Last Update Date | 06/09/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215003470 | NPI | - | NPPES |
| 366026600 | Other | CA | DEPARTMENT OF LABOR ID |
| GR0060600 | Medicaid | CA | |
| 3000 | Other | CA | NEIC SITE ID, NSF BA0-7 |
| ZZZ59748Z | Other | CA | BLUE CROSS BLUE SHIELD ID |
| CAME25 | Other | CA | UNIVERSAL ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
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