Basic Information
| Provider Information | |||||||||
| NPI: | 1083645352 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HOSPITAL SPECIALIST GROUP, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 345 S HALCYON RD | ||||||||
| Address2: | |||||||||
| City: | ARROYO GRANDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934203896 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8054894261 | ||||||||
| FaxNumber: | 8059945415 | ||||||||
| Practice Location | |||||||||
| Address1: | 345 S HALCYON RD | ||||||||
| Address2: | |||||||||
| City: | ARROYO GRANDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934203896 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8054894261 | ||||||||
| FaxNumber: | 8059945415 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | ECARMA | ||||||||
| AuthorizedOfficialFirstName: | ALEX | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8054894261 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | GR0099740 | 05 | CA | MEDICAID |