Provider Demographics
NPI:1518363555
Name:BAY AREA SURGICAL SPECIALISTS, INC
Entity Type:Organization
Organization Name:BAY AREA SURGICAL SPECIALISTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:PITTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-948-8143
Mailing Address - Street 1:2350 COUNTRY HILLS DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-7436
Mailing Address - Country:US
Mailing Address - Phone:925-757-0800
Mailing Address - Fax:925-757-2160
Practice Address - Street 1:365 LENNON LN
Practice Address - Street 2:SUITE
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-5910
Practice Address - Country:US
Practice Address - Phone:925-932-6330
Practice Address - Fax:925-627-3560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-18
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA95275207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA119198Medicare PIN