1477503381 NPI number — SAN JOSE CARDIAC SURGERY GRP

Table of content: (NPI 1477503381)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477503381 NPI number — SAN JOSE CARDIAC SURGERY GRP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAN JOSE CARDIAC SURGERY GRP
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:
1477503381
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/27/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15215 NATIONAL AVE STE 103
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS GATOS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95032-2425
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-559-1018
Provider Business Mailing Address Fax Number:
408-371-3025

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15215 NATIONAL AVE STE 103
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS GATOS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95032-2425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-559-1018
Provider Business Practice Location Address Fax Number:
408-371-3025
Provider Enumeration Date:
05/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SCHWARTZ
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
ADMINISTRATOR PARTNER
Authorized Official Telephone Number:
408-559-1018

Provider Taxonomy Codes

  • Taxonomy code: 208G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: ZZZ16883Z . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00G630840 . This is a "MEDI-CAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: EG63084 . This is a "CHAMPUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: CN5287 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00C382510 . This is a "MEDI-CAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00G488080 . This is a "MEDI-CAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: EG48808 . This is a "CHAMPUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: HC382510 . This is a "HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: GR0081260 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: HG48808 . This is a "HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: HG63084 . This is a "HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: PG48808 . This is a "PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: PG63084 . This is a "PPO" identifier . This identifiers is of the category "OTHER".




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