Provider Demographics
NPI:1518937051
Name:MILLS-PENINSULA HEALTH SERVICES
Entity Type:Organization
Organization Name:MILLS-PENINSULA HEALTH SERVICES
Other - Org Name:PENINSULA HOSPITAL AND MILLS HOSPITAL
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO SHBA
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:GATES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-450-7357
Mailing Address - Street 1:PO BOX 742738
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-2738
Mailing Address - Country:US
Mailing Address - Phone:650-696-5400
Mailing Address - Fax:650-652-3052
Practice Address - Street 1:1501 TROUSDALE DR
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-4506
Practice Address - Country:US
Practice Address - Phone:650-696-5400
Practice Address - Fax:650-652-3052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-26
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA282N00000X, 291U00000X
291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHSP30007GMedicaid
CAHSP40007GMedicaid
CAHSP40007GMedicaid