Mission Internal Medical Group, Inc.

Primary specialty

Endoscopy Clinic/CenterTaxonomy code 261QE0800X

License

060000510 Issued in CA

Legal business name

MISSION INTERNAL MEDICAL GROUP, INC.

Practice address

27871 Medical Center Rd
Suite 200
Mission Viejo, CA 92691-6404

Phone

(949) 347-8314

Fax

(949) 364-5427

NPI assigned

Jan 9, 2006

Reactivated

Oct 5, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Dennis A Wolin

Title

Ceo

Phone

(949) 282-1617

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1136764800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1274659200000",
    "number": "1750369708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26522 LA ALAMEDA",
            "address_2": "SUITE 120",
            "city": "MISSION VIEJO",
            "state": "CA",
            "postal_code": "926916330",
            "telephone_number": "949-282-1671",
            "fax_number": "949-367-0518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27871 MEDICAL CENTER RD",
            "address_2": "SUITE 200",
            "city": "MISSION VIEJO",
            "state": "CA",
            "postal_code": "926916404",
            "telephone_number": "949-347-8314",
            "fax_number": "949-364-5427"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSION INTERNAL MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-09",
        "last_updated": "2010-05-24",
        "deactivation_date": "2007-02-06",
        "reactivation_date": "2007-10-05",
        "status": "A",
        "authorized_official_last_name": "WOLIN",
        "authorized_official_first_name": "DENNIS",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "949-282-1617",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QE0800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Endoscopy",
            "state": "CA",
            "license": "060000510",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SUR01415F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mission Hospital Regional Medical Center
• Mission Hospital Regional Medical Center
• Mission Hospital Regional Medical Center
• Mission Internal Medical Froup, Inc.
• Mission Internal Medical Group, Inc.
• Mission Internal Medical Group, Inc.
• Mission Medical Urgent Care
• Mission Pathology Medical Associates
• Mission Pediatric Dentistry
• Mission Pediatric Med CL

• Endoscopy Clinic/Center in Mission Viejo, CA
• Providers in Mission Viejo, CA by specialty
• Endoscopy Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.