MEDICARE: RADIATION 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
1	174400000X	Specialist

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	:	1508864000
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RADIATION MEDICAL GROUP INC

Provider Business Mailing Address
First Line	:	PO BOX 33865
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92163-3865
Country	:	US
Telephone Number	:	619-220-4100
Fax Number	:	619-270-3423

Provider Business Practice Location Address
First Line	:	6699 ALVARADO RD
Second Line	:	STE 2109
City	:	SAN DIEGO
State	:	CA
Zip	:	92120-5238
Country	:	US
Telephone Number	:	619-229-3838
Fax Number	:	619-229-3849

Authorized Official
Title or Position	:	CFO/EXECUTIVE DIRECTOR
Name	:	DOUGLAS G MYKING
Credential	:	MBA
Telephone Number	:	619-220-4100

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	03/03/2009

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Directions to “RADIATION MEDICAL GROUP INC ” Practice Location

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