1720137565 NPI number — JOHN MUIR TRAUMA PHYSICIANS BILLING SERVICE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720137565 NPI number — JOHN MUIR TRAUMA PHYSICIANS BILLING SERVICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHN MUIR TRAUMA PHYSICIANS BILLING SERVICE
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:
1720137565
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/23/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1400 TREAT BLVD
Provider Second Line Business Mailing Address:
3RD FLOOR
Provider Business Mailing Address City Name:
WALNUT CREEK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94597-2142
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-947-5331
Provider Business Mailing Address Fax Number:
925-941-2177

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1601 YGNACIO VALLEY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WALNUT CREEK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94598-3122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-947-5331
Provider Business Practice Location Address Fax Number:
925-941-2177
Provider Enumeration Date:
01/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
THOMAS
Authorized Official First Name:
MIKE
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
925-941-2100

Provider Taxonomy Codes

  • Taxonomy code: 208M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: GR002814D , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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