Healthcare Provider Details

I. General information

NPI: 1932108115
Provider Name (Legal Business Name): NORTH COUNTY INPATIENT MEDICAL ALLIANCE, A MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 11/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

354 SANTA FE DR
ENCINITAS CA
92024-5142
US

IV. Provider business mailing address

PO BOX 231189
ENCINITAS CA
92023-1189
US

V. Phone/Fax

Practice location:
  • Phone: 760-230-2251
  • Fax: 760-230-2253
Mailing address:
  • Phone: 760-230-2251
  • Fax: 760-230-2253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number17910
License Number StateCA

VIII. Authorized Official

Name: DR. RONALD MACCORMICK
Title or Position: PRESIDENT
Credential: M.D.
Phone: 760-230-2251