MEDICARE: INLAND HEALTHCARE GROUP, A MEDICAL CORPORATION

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
1	207Q00000X	Family Medicine Physician

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235309428
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INLAND HEALTHCARE GROUP, A MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	PO BOX 10488
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92423-0488
Country	:	US
Telephone Number	:	888-344-9111
Fax Number	:	909-335-7130

Provider Business Practice Location Address
First Line	:	1033 N WATERMAN AVE
Second Line	:	SUITE E
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92410-3823
Country	:	US
Telephone Number	:	909-383-9385
Fax Number	:	909-383-4009

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CAREY PAUL
Credential	:
Telephone Number	:	909-335-7171

Provider Enumeration Date	:	03/04/2008
Last Update Date	:	05/24/2011

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