MEDICARE: ARROWHEAD RADIOLOGY MEDICAL GROUP INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	2085N0904X	Nuclear Radiology Physician	CA
2	2085R0204X	Vascular & Interventional Radiology Physician	CA
3	2085U0001X	Diagnostic Ultrasound Physician	CA
4	2085R0202X	Diagnostic Radiology Physician	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861592610
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARROWHEAD RADIOLOGY MEDICAL GROUP INC

Provider Business Mailing Address
First Line	:	400 N PEPPER AVE
Second Line	:
City	:	COLTON
State	:	CA
Zip	:	92324-1801
Country	:	US
Telephone Number	:	909-580-1520
Fax Number	:	909-580-1561

Provider Business Practice Location Address
First Line	:	29101 HOSPITAL RD
Second Line	:
City	:	LK ARROWHEAD
State	:	CA
Zip	:	92352-0070
Country	:	US
Telephone Number	:	909-336-3651
Fax Number	:	909-336-7492

Authorized Official
Title or Position	:	PRESIDENT
Name	:	FREDRICK L ORR
Credential	:	M.D.
Telephone Number	:	909-336-3651

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	08/12/2008

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