Provider Demographics
NPI:1205839636
Name:BAY AREA SURGICAL ASSOCIATES, INC
Entity Type:Organization
Organization Name:BAY AREA SURGICAL ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:P
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-798-4607
Mailing Address - Street 1:401 GREGORY LN
Mailing Address - Street 2:STE 204
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-2842
Mailing Address - Country:US
Mailing Address - Phone:925-798-4606
Mailing Address - Fax:925-798-4671
Practice Address - Street 1:401 GREGORY LN
Practice Address - Street 2:STE 204
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-2842
Practice Address - Country:US
Practice Address - Phone:925-798-4606
Practice Address - Fax:925-798-4671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43945208600000X
CAG540542086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Not Answered2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ24675ZMedicare ID - Type Unspecified