Provider Demographics
NPI:1073523577
Name:BAY WEST FAMILY HEALTHCARE MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:BAY WEST FAMILY HEALTHCARE MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BISHOP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-550-4710
Mailing Address - Street 1:1580 VALENCIA ST STE 201
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-4420
Mailing Address - Country:US
Mailing Address - Phone:415-550-4710
Mailing Address - Fax:415-550-6784
Practice Address - Street 1:1580 VALENCIA ST STE 201
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-4420
Practice Address - Country:US
Practice Address - Phone:415-550-4710
Practice Address - Fax:415-550-6784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207Q00000X207Q00000X
CA207R00000X207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ95079ZMedicare ID - Type Unspecified
CAA44251Medicare UPIN
CAA46752Medicare UPIN
CAA86616Medicare UPIN
CAG22365Medicare UPIN
CAH93082Medicare UPIN
CAGR0081800Medicare ID - Type Unspecified
CAA63463Medicare UPIN
CAG46274Medicare UPIN
CAG62591Medicare UPIN