1831291350 NPI number — EAST BAY PEDIATRICS INC

Table of content: (NPI 1831291350)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831291350 NPI number — EAST BAY PEDIATRICS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EAST BAY PEDIATRICS 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:
EAST BAY PEDIATRIC PRIMARY CARE INC
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:
1831291350
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2324 SANTA RITA RD
Provider Second Line Business Mailing Address:
SUITE 12
Provider Business Mailing Address City Name:
PLEASANTON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94566-4152
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-462-7700
Provider Business Mailing Address Fax Number:
925-462-7712

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2324 SANTA RITA RD
Provider Second Line Business Practice Location Address:
SUITE 12
Provider Business Practice Location Address City Name:
PLEASANTON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94566-4152
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-462-7700
Provider Business Practice Location Address Fax Number:
925-462-7700
Provider Enumeration Date:
09/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JUMIG
Authorized Official First Name:
ELMER
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
925-462-7700

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  A77244 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 95999 . This is a "PACIFICARE ID #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00A772440 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 06311574 . This is a "CIGNA PROVIDER #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 7473685 . This is a "AETNA PROVIDER #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 2667817 . This is a "UNITED PROVIDER #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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