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NPI Code Detail

MEDICARE: SANTA BARBARA RADIOLOGY MEDICAL GROUP INC

MEDICARE: SANTA BARBARA 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 License Number State
12085R0202XDiagnostic Radiology Physician

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3CS8932OTHERRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1ZZZ49598ZOTHERBLUE SHIELD OF CA
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1073505715
Entity Type Code : Organization
Provider Name (Legal Business Name) : SANTA BARBARA RADIOLOGY MEDICAL GROUP INC
Provider Business Mailing Address
First Line : PO BOX 4219
Second Line :
City : ORANGE
State : CA
Zip : 92863-4219
Country : US
Telephone Number : 714-571-5000
Fax Number : 714-571-5055
Provider Business Practice Location Address
First Line : 400 W PUEBLO ST
Second Line :
City : SANTA BARBARA
State : CA
Zip : 93105-4353
Country : US
Telephone Number : 805-569-7279
Fax Number : 805-569-8279
Authorized Official
Title or Position : PRESIDENT
Name : THOMAS C. DAUGHTERS
Credential : M.D.
Telephone Number : 805-569-7279
Provider Enumeration Date : 08/18/2005
Last Update Date : 01/20/2014

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