1730115247 NPI number — TK SVENSSON MD & S MORROW MD INC

Table of content: (NPI 1730115247)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730115247 NPI number — TK SVENSSON MD & S MORROW MD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TK SVENSSON MD & S MORROW MD 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:
CLINICAL TRAINING & RESEARCH INSTITUTE
Provider Other Organization Name Type Code:
3
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:
1730115247
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/31/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25 EDWARDS CT STE 105
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BURLINGAME
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94010-2421
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-342-1966
Provider Business Mailing Address Fax Number:
650-685-6552

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25 EDWARDS CT STE 105
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:
94010-2421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-504-3801
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SVENSSON
Authorized Official First Name:
TRAVIS
Authorized Official Middle Name:
K
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
650-342-1966

Provider Taxonomy Codes

  • Taxonomy code: 2084A0401X , with the licence number:  G80502 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: G80502 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208D00000X , with the licence number: G80502 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0000X , with the licence number: G80502 , 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: 0001131400 . This is a "MANAGED HEALTH NETWORK" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 466412213 . This is a "TRICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 344648 . This is a "MHN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 466412213 . This is a "UNITED BEHAVIORAL HEALTH" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 0005381727 . This is a "AETNA USA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 80504 . This is a "SAN MATEO COUNTY MENTAL H" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 466412213 . This is a "MAGELLAN BEHAVIORAL HEALT" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 5578-03 . This is a "PACIFICARE BEHAVIORAL HEA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 3697319 . This is a "AETNA HEALTH CALIFORNIA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 15-65929 . This is a "UNITED HEALTHCARE SERVICE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 151885 . This is a "VALUE OPTIONS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1565929 . This is a "USBEHAVIORALHEALTHPLAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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