Provider Demographics
NPI:1407940224
Name:GASTROENTEROLOGY ASSOCIATES OF THE EAST BAY MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:GASTROENTEROLOGY ASSOCIATES OF THE EAST BAY MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ATWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-292-4528
Mailing Address - Street 1:2510 WEBSTER STREET
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705
Mailing Address - Country:US
Mailing Address - Phone:510-548-6555
Mailing Address - Fax:510-548-3761
Practice Address - Street 1:2510 WEBSTER STREET
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705
Practice Address - Country:US
Practice Address - Phone:510-548-6555
Practice Address - Fax:510-548-3761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ14052ZMedicare ID - Type Unspecified
CAZZZ14052ZMedicare UPIN