1134127541 NPI number — CENTRAL COAST CARDIOLOGY A MEDICAL CORPORATION

Table of content: (NPI 1134127541)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134127541 NPI number — CENTRAL COAST CARDIOLOGY A MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL COAST CARDIOLOGY A MEDICAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CENTRAL COAST CARDIOLOGY
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134127541
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/03/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
230 SAN JOSE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALINAS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93901-3901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
831-758-2100
Provider Business Mailing Address Fax Number:
831-758-1565

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
230 SAN JOSE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALINAS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93901-3901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-758-2100
Provider Business Practice Location Address Fax Number:
831-758-1565
Provider Enumeration Date:
07/09/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ALBERT
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
831-758-2100

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207UN0901X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: GR0059320 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZZ39580Z . This is a "BLUE SHIELD FOR SALINAS CD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ55762Z . This is a "BLUE SHIELD FOR MONTEREY CD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ53511Y . This is a "BLUE SHIELD FOR MONTEREY IM" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ56339Z . This is a "BLUE SHIELD FOR SALINAS IM" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".