1730118795 NPI number — SAFEWAY INC

Table of content: J CHRISTOPHER BRANDYS MD FRCS FACS (NPI 1588618391)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730118795 NPI number — SAFEWAY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAFEWAY INC
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:
1730118795
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/12/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5918 STONERIDGE MALL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLEASANTON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94588-3229
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-467-2811
Provider Business Mailing Address Fax Number:
925-467-2802

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7150 LEETSDALE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80224-3529
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-377-7116
Provider Business Practice Location Address Fax Number:
303-355-4177
Provider Enumeration Date:
07/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CALARA
Authorized Official First Name:
RITA
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGED CARE PLAN SPECIALIST
Authorized Official Telephone Number:
925-467-2811

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  228 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 03001658 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0609808 . This is a "NCPDP" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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