Provider Demographics
NPI: | 1417498825 |
---|---|
Name: | BAYCHILDREN'S PHYSICIANS |
Entity Type: | Organization |
Organization Name: | BAYCHILDREN'S PHYSICIANS |
Other - Org Name: | UBCP BANCROFT PEDIATRICS |
Other - Org Type: | Other Name |
Authorized Official - Title/Position: | CHIEF EXECUTIVE OFFICER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | MITCHELL |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | NEYHART |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 415-476-4407 |
Mailing Address - Street 1: | 6475 CHRISTIE AVE |
Mailing Address - Street 2: | SUITE 300 |
Mailing Address - City: | EMERYVILLE |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 94608-1095 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1555 DOOLITTLE DR |
Practice Address - Street 2: | #180 |
Practice Address - City: | SAN LEANDRO |
Practice Address - State: | CA |
Practice Address - Zip Code: | 94577-2239 |
Practice Address - Country: | US |
Practice Address - Phone: | 510-483-2600 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | BAYCHILDREN'S PHYSICIANS |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2017-03-17 |
Last Update Date: | 2017-03-17 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Single Specialty |