1609236496 NPI number — BAY AREA SURGICAL SPECIALISTS, INC A MEDICAL CORPORATION

Table of content: (NPI 1609236496)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609236496 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:
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:
1609236496
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/30/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
365 LENNON LN
Provider Second Line Business Mailing Address:
SUITE 250
Provider Business Mailing Address City Name:
WALNUT CREEK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94598-5910
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-627-3424
Provider Business Mailing Address Fax Number:
925-627-3560

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1050 NORTHGATE DR
Provider Second Line Business Practice Location Address:
SUITE 460
Provider Business Practice Location Address City Name:
SAN RAFAEL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94903-2526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-287-1256
Provider Business Practice Location Address Fax Number:
925-287-0913
Provider Enumeration Date:
03/07/2016

Additional Information

Authorized Official

Authorized Official Last Name:
PITTMAN
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
925-948-8143

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208VP0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





Copyright © 2007-2025 www.npivalidator.com