1740279959 NPI number — SUTTER EAST BAY HOSPITALS

Table of content: (NPI 1740279959)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740279959 NPI number — SUTTER EAST BAY HOSPITALS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUTTER EAST BAY HOSPITALS
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:
ALTA BATES SUMMIT MED CENTER - SUMMIT CAMPUS
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:
1740279959
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 742920
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:
90074-2920
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
855-398-1633
Provider Business Mailing Address Fax Number:
510-658-8593

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
350 HAWTHORNE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94609-3108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-655-4000
Provider Business Practice Location Address Fax Number:
510-658-8593
Provider Enumeration Date:
10/19/2005

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 , with the licence number:  140000284 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 291U00000X , with the licence number: 140000284 , 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: HSP40043G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZR00043G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: HSC00043G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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