Provider Demographics
NPI:1104357359
Name:BAYCHILDREN'S PHYSICIANS
Entity Type:Organization
Organization Name:BAYCHILDREN'S PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOC DIRECTOR REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HALLGREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-476-4404
Mailing Address - Street 1:6475 CHRISTIE AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94608-1095
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3000 COLBY ST STE 301
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2058
Practice Address - Country:US
Practice Address - Phone:510-486-8344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAYCHILDREN'S PHYSICIANS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-21
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty