Provider Demographics
NPI:1356817886
Name:BICYCLE HEALTH PROVIDER GROUP INC.
Entity Type:Organization
Organization Name:BICYCLE HEALTH PROVIDER GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-731-7315
Mailing Address - Street 1:P.O. BOX 32750
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-0220
Mailing Address - Country:US
Mailing Address - Phone:844-943-2514
Mailing Address - Fax:
Practice Address - Street 1:617 VETERANS BLVD STE 101
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-1404
Practice Address - Country:US
Practice Address - Phone:844-943-2514
Practice Address - Fax:628-777-2580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-23
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Multi-Specialty