Provider Demographics
NPI:1497971584
Name:PERMANENTE MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:PERMANENTE MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:T
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-295-7207
Mailing Address - Street 1:TPMG FINANCIAL MANAGEMENT
Mailing Address - Street 2:1950 FRANKLIN, 18TH FLOOR
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-5103
Mailing Address - Country:US
Mailing Address - Phone:510-987-1000
Mailing Address - Fax:
Practice Address - Street 1:5755 COTTLE RD BLDG 6
Practice Address - Street 2:TPMG REGIONAL GENETICS LAB
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-3640
Practice Address - Country:US
Practice Address - Phone:408-972-3308
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PERMANENTE MEDICAL GROUP, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-17
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF 11121291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory