Provider Demographics
NPI:1376844753
Name:CENTER FOR COLORECTAL HEALTH INC
Entity Type:Organization
Organization Name:CENTER FOR COLORECTAL HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MYRIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HEFFERNAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-765-0413
Mailing Address - Street 1:450 SUTTER ST
Mailing Address - Street 2:SUITE 1019
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108-4206
Mailing Address - Country:US
Mailing Address - Phone:415-765-0413
Mailing Address - Fax:415-765-1758
Practice Address - Street 1:450 SUTTER ST
Practice Address - Street 2:SUITE 1019
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-4206
Practice Address - Country:US
Practice Address - Phone:415-765-0413
Practice Address - Fax:415-765-1758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-16
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG85165208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty