1932256294 NPI number — MARINER MEDICAL CENTER

Table of content: (NPI 1932256294)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932256294 NPI number — MARINER MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARINER MEDICAL CENTER
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:
1932256294
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/11/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1241 E HILLSDALE BLVD
Provider Second Line Business Mailing Address:
2ND FLOOR
Provider Business Mailing Address City Name:
FOSTER CITY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94404-1241
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-570-2299
Provider Business Mailing Address Fax Number:
650-570-5949

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1261 E HILLSDALE BLVD
Provider Second Line Business Practice Location Address:
STE 1
Provider Business Practice Location Address City Name:
FOSTER CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94404-1236
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-570-2299
Provider Business Practice Location Address Fax Number:
650-570-5949
Provider Enumeration Date:
01/05/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SAUERMANN
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
650-570-2299

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  A83248 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: G48428 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Q00000X , with the licence number: A80784 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: G79688 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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