1518937051 NPI number — MILLS-PENINSULA HEALTH SERVICES

Table of content: WILLIAM ANDREW TYNDALL M.D. (NPI 1225133424)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518937051 NPI number — MILLS-PENINSULA HEALTH SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MILLS-PENINSULA HEALTH SERVICES
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:
PENINSULA HOSPITAL AND MILLS HOSPITAL
Provider Other Organization Name Type Code:
5
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:
1518937051
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/21/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 742738
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90074-2738
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-696-5400
Provider Business Mailing Address Fax Number:
650-652-3052

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1501 TROUSDALE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BURLINGAME
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94010-4506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-696-5400
Provider Business Practice Location Address Fax Number:
650-652-3052
Provider Enumeration Date:
01/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GATES
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO SHBA
Authorized Official Telephone Number:
510-450-7357

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 291U00000X , 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: HSP30007G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: HSP40007G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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