Provider Demographics
NPI:1265496756
Name:CHILDRENS ANESTHESIA MEDICAL GROUP INC
Entity Type:Organization
Organization Name:CHILDRENS ANESTHESIA MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JODY
Authorized Official - Middle Name:
Authorized Official - Last Name:HINTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-854-3822
Mailing Address - Street 1:PO BOX 45731
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94145-0731
Mailing Address - Country:US
Mailing Address - Phone:888-854-3822
Mailing Address - Fax:817-877-0350
Practice Address - Street 1:747 52ND ST
Practice Address - Street 2:DEPARTMENT OF ANESTHESIOLOGY
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-1809
Practice Address - Country:US
Practice Address - Phone:510-428-3070
Practice Address - Fax:510-450-5853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-13
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0026490Medicaid
CAGR0026490Medicaid