Provider Demographics
NPI:1326170374
Name:BAY AREA PAIN MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:BAY AREA PAIN MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:KEANEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:415-380-0480
Mailing Address - Street 1:3 HARBOR DR
Mailing Address - Street 2:SUITE 115
Mailing Address - City:SAUSALITO
Mailing Address - State:CA
Mailing Address - Zip Code:94965-1454
Mailing Address - Country:US
Mailing Address - Phone:415-380-0480
Mailing Address - Fax:
Practice Address - Street 1:3 HARBOR DR
Practice Address - Street 2:SUITE 115
Practice Address - City:SAUSALITO
Practice Address - State:CA
Practice Address - Zip Code:94965-1454
Practice Address - Country:US
Practice Address - Phone:415-380-0480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC384062084P2900X
CAC392262084P2900X
CA11549363LF0000X
CA370895364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ25433ZMedicare PIN