Provider Demographics
NPI:1336113521
Name:SURGICAL PHYSICIAN ASSISTANTS, INC.
Entity Type:Organization
Organization Name:SURGICAL PHYSICIAN ASSISTANTS, INC.
Other - Org Name:SURGICAL PROFESSIONALS ALLIANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:IRENE
Authorized Official - Last Name:DUNNING
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:510-448-6772
Mailing Address - Street 1:PO BOX 592
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-9692
Mailing Address - Country:US
Mailing Address - Phone:510-448-6772
Mailing Address - Fax:925-215-2251
Practice Address - Street 1:350 HAWTHORNE AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3108
Practice Address - Country:US
Practice Address - Phone:510-655-4000
Practice Address - Fax:925-215-2251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11518363AS0400X
CA11627363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS25716Medicare UPIN
CAZZZ29800ZMedicare ID - Type UnspecifiedGROUP MEDICARE NUMBER
CAR23395Medicare UPIN