Organization
MIDCOAST IMAGING MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID MCANINCH MD (DELEGATED OFFICIAL)
(805) 737-3375
Entity
Organization
Contact information
Practice address
1515 E OCEAN AVE, LOMPOC, CA 93436-7092
(805) 737-3375
Mailing address
PO BOX 7462, ORANGE, CA 92863-7462
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CP1084
RALROAD MEDICARE
—
05
—
GR0013010
—
CA
Enumeration date
08/31/2005
Last updated
04/12/2021
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