1659558369 NPI number — NORTH EAST MEDICAL SERVICES

Table of content: (NPI 1659558369)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659558369 NPI number — NORTH EAST MEDICAL SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH EAST MEDICAL SERVICES
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:
NORTH EAST MEDICAL SERVICES- LELAND
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:
1659558369
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/10/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1520 STOCKTON STREET
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:
94133-3354
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-391-9686
Provider Business Mailing Address Fax Number:
415-433-4726

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
82 LELAND AVENUE
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:
94134-2804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-391-9686
Provider Business Practice Location Address Fax Number:
415-333-9067
Provider Enumeration Date:
01/24/2008

Additional Information

Authorized Official

Authorized Official Last Name:
CHAN
Authorized Official First Name:
EDDIE
Authorized Official Middle Name:
W
Authorized Official Title or Position:
PRESIDENT & CEO
Authorized Official Telephone Number:
415-391-9686

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , with the licence number:  220000359 , 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: BCP70714G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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