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200 W Arbor Dr San Diego CA 92103-9000 | |
| (800) 926-8273 | |
| (888) 539-8781 |
| Full Name | |
|---|---|
| Speciality | Internal Medicine |
| Location | 200 W Arbor Dr, San Diego, California |
| Authorized Official Name and Position | Michael Dennis Price (DIRECTOR, REVENUE CYCLE & OPERATION) |
| Authorized Official Contact | 8582496752 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 232410 San Diego CA 92193-2410 Ph: () - | 200 W Arbor Dr San Diego CA 92103-9000 Ph: (800) 926-8273 |
| NPI Number | 1336267137 |
|---|---|
| Provider Enumeration Date | 03/27/2007 |
| Last Update Date | 04/01/2024 |
| Medicare PECOS PAC ID | 3577476761 |
|---|---|
| Medicare Enrollment ID | O20110720000510 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336267137 | NPI | - | NPPES |
| ZZZP3708Z | Medicaid | CA | |
| GR0013562 | Medicaid | CA | |
| CQ4024 | Other | CA | RAILROAD MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | (* (Not Available)) | Primary |
| 207RI0008X | Internal Medicine - Hepatology | (* (Not Available)) | Secondary |
| Provider Name | Jonathan Bold |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1053390021 PECOS PAC ID: 0042100679 Enrollment ID: I20040317001401 |
| Provider Name | Scott Chang |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1962454645 PECOS PAC ID: 9537146212 Enrollment ID: I20040630000981 |
| Provider Name | Jeffrey V Behar |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1912987942 PECOS PAC ID: 6406759687 Enrollment ID: I20050427001122 |
| Provider Name | Christopher Hurt |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1497866214 PECOS PAC ID: 4880744275 Enrollment ID: I20110919000700 |
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