Provider Demographics
NPI:1003934266
Name:KAISER FOUNDATION HEALTH PLAN
Entity Type:Organization
Organization Name:KAISER FOUNDATION HEALTH PLAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:REVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:211-265-8810
Mailing Address - Street 1:1001 LAKESIDE AVE
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44114
Mailing Address - Country:US
Mailing Address - Phone:216-265-8844
Mailing Address - Fax:216-265-8890
Practice Address - Street 1:1001 LAKESIDE AVE
Practice Address - Street 2:SUITE 1200
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44114
Practice Address - Country:US
Practice Address - Phone:216-265-8844
Practice Address - Fax:216-265-8890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization