Provider Demographics
NPI:1235172875
Name:SAN MATEO COUNTY MEDICAL CENTER
Entity Type:Organization
Organization Name:SAN MATEO COUNTY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:KRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ROZZI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-573-2120
Mailing Address - Street 1:222 W 39TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-4364
Mailing Address - Country:US
Mailing Address - Phone:650-573-2120
Mailing Address - Fax:
Practice Address - Street 1:222 W 39TH AVE
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-4364
Practice Address - Country:US
Practice Address - Phone:650-573-2120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0061320Medicaid
CAGR0029110Medicaid
CAGR0028850Medicaid
CAGR0028880Medicaid
CAGR0028888Medicaid
CAGR0053920Medicaid
CAGR0028886Medicaid
CAGR0028860Medicaid
CAGR0028950Medicaid
CAGR0029110Medicaid
CAGR0028888Medicaid
CAZZZ93244ZMedicare ID - Type Unspecified
CAGR0053920Medicaid
CAZZZ93233ZMedicare ID - Type Unspecified
CAZZZ93227ZMedicare ID - Type Unspecified
CAZZZ93231ZMedicare ID - Type Unspecified
CAGR0028850Medicaid
CAZZZ93218ZMedicare ID - Type Unspecified
CAZZZ93234ZMedicare ID - Type Unspecified
CAZZZ93232ZMedicare ID - Type Unspecified