1205839636 NPI number — BAY AREA SURGICAL ASSOCIATES, INC

Table of content: (NPI 1205839636)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205839636 NPI number — BAY AREA SURGICAL ASSOCIATES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAY AREA SURGICAL ASSOCIATES, INC
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:
Provider Other Organization Name Type Code:
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:
1205839636
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
401 GREGORY LN
Provider Second Line Business Mailing Address:
STE 204
Provider Business Mailing Address City Name:
PLEASANT HILL
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94523-2842
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-798-4606
Provider Business Mailing Address Fax Number:
925-798-4671

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 GREGORY LN
Provider Second Line Business Practice Location Address:
STE 204
Provider Business Practice Location Address City Name:
PLEASANT HILL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94523-2842
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-798-4606
Provider Business Practice Location Address Fax Number:
925-798-4671
Provider Enumeration Date:
05/31/2005

Additional Information

Authorized Official

Authorized Official Last Name:
WOOD
Authorized Official First Name:
LISA
Authorized Official Middle Name:
P
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
925-798-4607

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  A43945 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 2086S0129X , with the licence number: G54054 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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





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