Provider Demographics
NPI:1861539280
Name:CONSERVATIVE CARE SPECIALISTS MEDICAL GROUP INC
Entity type:Organization
Organization Name:CONSERVATIVE CARE SPECIALISTS MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAYSON
Authorized Official - Middle Name:A
Authorized Official - Last Name:HYMES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-781-6684
Mailing Address - Street 1:PO BOX 5486
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92863-5486
Mailing Address - Country:US
Mailing Address - Phone:818-550-0900
Mailing Address - Fax:303-953-8260
Practice Address - Street 1:6815 NOBLE AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405
Practice Address - Country:US
Practice Address - Phone:818-781-6684
Practice Address - Fax:818-781-4457
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CONSERVATIVE CARE SPECIALISTS MEDICAL GROUP INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-01
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG056728207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0065790Medicaid
CAGR0065790Medicaid