1538240866 NPI number — GOLDEN GATE ENDOSCOPY CENTER, LLC

Table of content: (NPI 1538240866)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538240866 NPI number — GOLDEN GATE ENDOSCOPY CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GOLDEN GATE ENDOSCOPY CENTER, LLC
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:
1538240866
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/07/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 39000
Provider Second Line Business Mailing Address:
DEPT. 33940
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94139-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-493-7729
Provider Business Mailing Address Fax Number:
650-493-7959

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3370 GEARY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94118-3324
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-379-7500
Provider Business Practice Location Address Fax Number:
415-379-7505
Provider Enumeration Date:
10/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FIELDS
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
M
Authorized Official Title or Position:
VP/CONTROLLER
Authorized Official Telephone Number:
205-545-2752

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  550000401 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com