1447359310 NPI number — RENAL MEDICAL ASSOCIATES

Table of content: (NPI 1447359310)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447359310 NPI number — RENAL MEDICAL ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RENAL MEDICAL ASSOCIATES
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:
1447359310
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/30/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2100 WEBSTER ST STE 320
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:
94115-2377
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-923-3456
Provider Business Mailing Address Fax Number:
415-923-3121

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2100 WEBSTER ST STE 320
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:
94115-2377
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-923-3456
Provider Business Practice Location Address Fax Number:
415-923-3121
Provider Enumeration Date:
09/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BORAH
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
F
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
415-923-3456

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00A517650 . This is a "STATE LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00A517651 . This is a "MEDICARE INDIVIDUAL PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00G623554 . This is a "MEDICARE INDIVIDUAL PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ19839Z . This is a "MEDICARE GROUP PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00G623550 . This is a "STATE LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00A517650 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00G623551 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00A997520 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00G203560 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00G203560 . This is a "STATE LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00G203562 . This is a "MEDICARE INDIVIDUAL PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00A521550 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: A52155 . This is a "LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00A521551 . This is a "MEDICARE INDIVIDUAL PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00A997520 . This is a "MEDICARE INDIVIDUAL PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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