Provider Demographics
NPI:1225283617
Name:BAY AREA MOBILE, INC
Entity Type:Organization
Organization Name:BAY AREA MOBILE, INC
Other - Org Name:INACTIVE DO NOT USE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:ALTMAN-STEELE
Authorized Official - Suffix:
Authorized Official - Credentials:ARRT, CRT
Authorized Official - Phone:415-378-3305
Mailing Address - Street 1:887 INDUSTRIAL RD STE G
Mailing Address - Street 2:
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070-3326
Mailing Address - Country:US
Mailing Address - Phone:650-802-9460
Mailing Address - Fax:866-846-1907
Practice Address - Street 1:887 INDUSTRIAL RD STE G
Practice Address - Street 2:
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-3326
Practice Address - Country:US
Practice Address - Phone:650-802-9460
Practice Address - Fax:866-846-1907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-26
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62380293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAN994Medicare UPIN