1235802760 NPI number — PEERWELL HEALTH PC

Table of content: (NPI 1235802760)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235802760 NPI number — PEERWELL HEALTH PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEERWELL HEALTH PC
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:
1235802760
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/30/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1460 MISSION ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94103-2511
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-607-6248
Provider Business Mailing Address Fax Number:
510-369-3813

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1500 16TH ST FL 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94103-5112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-607-6248
Provider Business Practice Location Address Fax Number:
510-369-3813
Provider Enumeration Date:
07/30/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SCHMIDT
Authorized Official First Name:
D JASPER
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
310-626-0149

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225XP0019X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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