Provider Demographics
NPI:1205033008
Name:BACK TO HEALTH MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:BACK TO HEALTH MEDICAL CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:P
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:925-287-8550
Mailing Address - Street 1:1100 PLEASANT VALLEY DR
Mailing Address - Street 2:SUITE A&B
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-4362
Mailing Address - Country:US
Mailing Address - Phone:925-287-8550
Mailing Address - Fax:925-287-8241
Practice Address - Street 1:1100 PLEASANT VALLEY DR
Practice Address - Street 2:SUITE A&B
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-4362
Practice Address - Country:US
Practice Address - Phone:925-287-8550
Practice Address - Fax:925-287-8241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherEIN NUMBER