Provider Demographics
NPI:1194835686
Name:EAST BAY ENDOSURGERY CENTER INC
Entity Type:Organization
Organization Name:EAST BAY ENDOSURGERY CENTER INC
Other - Org Name:EAST BAY ENDOSURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OF GENERAL PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:A
Authorized Official - Last Name:HOLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-665-1283
Mailing Address - Street 1:3300 WEBSTER ST
Mailing Address - Street 2:SUITE 308
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609
Mailing Address - Country:US
Mailing Address - Phone:510-763-3379
Mailing Address - Fax:510-763-3792
Practice Address - Street 1:300 FRANK OGAWA PLAZA
Practice Address - Street 2:SUITE 135
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612
Practice Address - Country:US
Practice Address - Phone:510-893-1600
Practice Address - Fax:510-893-2600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASUR01641FMedicaid
CAZZZ27454ZMedicare PIN