Provider Demographics
NPI:1437191087
Name:CITY & COUNTY OF SAN FRANCISCO
Entity Type:Organization
Organization Name:CITY & COUNTY OF SAN FRANCISCO
Other - Org Name:SOUTHEAST HEALTH CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF PFS
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:ISTVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-759-4064
Mailing Address - Street 1:1001 POTRERO AVE
Mailing Address - Street 2:BLDG 10 WARD 14 ROOM 1405
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110
Mailing Address - Country:US
Mailing Address - Phone:415-206-8338
Mailing Address - Fax:206-206-3837
Practice Address - Street 1:2401 KEITH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94124
Practice Address - Country:US
Practice Address - Phone:415-671-7000
Practice Address - Fax:415-822-3620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC11677GMedicaid
CAFHC11677GMedicaid