1821147786 NPI number — NORTHBAY HEALTHCARE GROUP

Table of content: (NPI 1821147786)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821147786 NPI number — NORTHBAY HEALTHCARE GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHBAY HEALTHCARE GROUP
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:
DBA NORTHBAY MEDICAL CENTER
Provider Other Organization Name Type Code:
3
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:
1821147786
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/16/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4500 BUSINESS CENTER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRFIELD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94534-6888
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:
707-646-4803

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4500 BUSINESS CENTER DR
Provider Second Line Business Practice Location Address:
PATIENT FINANCIAL SERVICES
Provider Business Practice Location Address City Name:
FAIRFIELD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94534-6888
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-646-3401
Provider Business Practice Location Address Fax Number:
707-646-4803
Provider Enumeration Date:
01/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
EICHENBERGER
Authorized Official First Name:
LORI
Authorized Official Middle Name:
Authorized Official Title or Position:
SENIOR DIRECTOR, REVENUE CYCLE MGMT
Authorized Official Telephone Number:
707-646-3400

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  110000093 , 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)

  • Identifier: ZZR00367F . This is a "MEDI-CAL INPATIENT" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: HSP40367F . This is a "MEDI-CAL OUTPATIENT" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1255483202 . This is a "NPI NORTHBAY VACAVALLEY HOSPITAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 110000093 . This is a "DHS LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: GR0093200 . This is a "MEDI-CAL PHYSICIAN GROUP" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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