Provider Demographics
NPI:1104014398
Name:GOLDEN GATE INPATIENT SERVICES
Entity Type:Organization
Organization Name:GOLDEN GATE INPATIENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ISCOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-355-0808
Mailing Address - Street 1:PO BOX 41743
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19101-1743
Mailing Address - Country:US
Mailing Address - Phone:214-712-2000
Mailing Address - Fax:214-712-2444
Practice Address - Street 1:900 HYDE ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-4806
Practice Address - Country:US
Practice Address - Phone:415-353-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherBLUE CROSS
CA=========OtherTRIWEST