1689634891 NPI number — SAN MATEO ENDOSCOPY CENTER

Table of content: (NPI 1689634891)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689634891 NPI number — SAN MATEO ENDOSCOPY CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAN MATEO ENDOSCOPY CENTER
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:
6
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:
1689634891
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
50 S. SAN MATEO DR.
Provider Second Line Business Mailing Address:
# 400
Provider Business Mailing Address City Name:
SAN MATEO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94401-3861
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-579-7082
Provider Business Mailing Address Fax Number:
650-579-7743

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50 S SAN MATEO DR
Provider Second Line Business Practice Location Address:
# 400
Provider Business Practice Location Address City Name:
SAN MATEO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94401-3857
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-579-7082
Provider Business Practice Location Address Fax Number:
650-579-7743
Provider Enumeration Date:
03/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MAINARDI
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
650-340-9977

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , 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: SUR01370F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4422407 . This is a "CIGNA ID" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 051370 . This is a "BLUE CROSS ID" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com