Provider Demographics
NPI:1285643528
Name:CHRYSALIS MEDICAL TECHNOLOGY, INC
Entity Type:Organization
Organization Name:CHRYSALIS MEDICAL TECHNOLOGY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:DAMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:415-457-7400
Mailing Address - Street 1:929 SIR FRANCIS DRAKE BLVD STE 101C
Mailing Address - Street 2:
Mailing Address - City:KENTFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94904-1548
Mailing Address - Country:US
Mailing Address - Phone:415-457-7400
Mailing Address - Fax:415-454-3200
Practice Address - Street 1:929 SIR FRANCIS DRAKE BLVD STE 101C
Practice Address - Street 2:
Practice Address - City:KENTFIELD
Practice Address - State:CA
Practice Address - Zip Code:94904-1548
Practice Address - Country:US
Practice Address - Phone:415-457-7400
Practice Address - Fax:415-454-3200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5113790001Medicare ID - Type UnspecifiedDURABLE MEDICAL EQUIPMENT