Provider Demographics
NPI:1598044166
Name:SAN FRANCISCO MEDICAL CENTER OUTPATIENT IMPROVEMENT PROGRAMS, INC
Entity Type:Organization
Organization Name:SAN FRANCISCO MEDICAL CENTER OUTPATIENT IMPROVEMENT PROGRAMS, INC
Other - Org Name:SOUTH OF MARKET HEALTH CENTER - EDITH WITT
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:E
Authorized Official - Last Name:RANGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-503-6054
Mailing Address - Street 1:229 7TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-4003
Mailing Address - Country:US
Mailing Address - Phone:415-503-6055
Mailing Address - Fax:415-503-6099
Practice Address - Street 1:66 9TH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-1427
Practice Address - Country:US
Practice Address - Phone:415-503-6000
Practice Address - Fax:415-503-6096
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAN FRANCISCO MEDICAL CENTER OUTPATIENT IMPROVEMENT PROGRAMS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-08-12
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA220000094261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC11425FMedicaid
EAP11425FOtherEAPC
CAHAP11425FMedicaid
05-1823Medicare PIN