Provider Demographics
NPI:1043543325
Name:ALAMEDA COUNTY MEDICAL GROUP
Entity Type:Organization
Organization Name:ALAMEDA COUNTY MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:GEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:DOTTERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-535-7609
Mailing Address - Street 1:15400 FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-1091
Mailing Address - Country:US
Mailing Address - Phone:510-346-1468
Mailing Address - Fax:510-894-7286
Practice Address - Street 1:15400 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-1091
Practice Address - Country:US
Practice Address - Phone:510-346-1468
Practice Address - Fax:510-894-7286
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALAMEDA COUNTY MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-09-17
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA05D0940091261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherEIN