Provider Demographics
NPI:1457496655
Name:TIDES CENTER
Entity Type:Organization
Organization Name:TIDES CENTER
Other - Org Name:THE TOM STEEL CLINIC, A PROJECT OF THE TIDES CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MILTON
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-383-6623
Mailing Address - Street 1:655 REDWOOD HWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-3034
Mailing Address - Country:US
Mailing Address - Phone:415-383-6623
Mailing Address - Fax:415-383-6671
Practice Address - Street 1:655 REDWOOD HWY
Practice Address - Street 2:200
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-3034
Practice Address - Country:US
Practice Address - Phone:415-383-6623
Practice Address - Fax:415-383-6671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherTAX ID NUMBER