1083171268 NPI number — BAY AREA SURGICAL SPECIALISTS INC A MEDICAL CORPORATION

Table of content: (NPI 1083171268)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083171268 NPI number — BAY AREA SURGICAL SPECIALISTS INC A MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAY AREA SURGICAL SPECIALISTS INC A MEDICAL CORPORATION
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:
BASS MEDICAL GROUP
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:
1083171268
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/25/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2637 SHADELANDS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WALNUT CREEK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94598-2512
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-948-8143
Provider Business Mailing Address Fax Number:
925-215-4540

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1208 E ARQUES AVE STE 113
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUNNYVALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94085-5419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-730-8082
Provider Business Practice Location Address Fax Number:
87-300-5484
Provider Enumeration Date:
02/25/2019

Additional Information

Authorized Official

Authorized Official Last Name:
RHODES
Authorized Official First Name:
GREGORY
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT, AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
925-932-6330

Provider Taxonomy Codes

  • Taxonomy code: 261QS1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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