1467444711 NPI number — NORTHERN CALIFORNIA CARDIOLOGY ASSOCIATES MEDICAL GROUP INC

Table of content: (NPI 1467444711)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467444711 NPI number — NORTHERN CALIFORNIA CARDIOLOGY ASSOCIATES MEDICAL GROUP INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHERN CALIFORNIA CARDIOLOGY ASSOCIATES MEDICAL GROUP 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:
1467444711
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/20/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1330 21ST STREET #201
Provider Second Line Business Mailing Address:
C/O MIDTOWN FINANCIAL
Provider Business Mailing Address City Name:
SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95811-4231
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-561-6848
Provider Business Mailing Address Fax Number:
916-447-9210

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5301 F ST
Provider Second Line Business Practice Location Address:
#117
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95819-3226
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-733-1788
Provider Business Practice Location Address Fax Number:
916-733-1787
Provider Enumeration Date:
08/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
VETTER
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
R.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
916-733-1788

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  207RC0000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RC0001X , with the licence number: 207RC0001X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0011X , with the licence number: 207R10011X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207UN0901X , with the licence number: 207UN0901X , 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)

  • Identifier: GR0063163 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZZ075232 . This is a "BLUE SHIELD OF CA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: DA7085 . This is a "RAILROAD MEDICARE PIN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: GR0063161 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZZ07524Z . This is a "BLUE SHIELD OF CA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ07522Z . This is a "BLUE SHIELD OF CA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: GR0063162 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: GR0063160 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: GR0063164 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZZ08053Z . This is a "BLUE SHIELD OF CA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ66346Z . This is a "BLUE SHIELD OF CA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: DB9095 . This is a "RAILROAD MEDICARE PIN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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