Provider Demographics
NPI:1639244262
Name:KAISER FOUNDATION HOSPITALS
Entity Type:Organization
Organization Name:KAISER FOUNDATION HOSPITALS
Other - Org Name:KAISER FOUNDATION HOSPITAL WALNUT CREEK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VICE PRESIDENT, AREA MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCKEOWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-295-5888
Mailing Address - Street 1:1425 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-5318
Mailing Address - Country:US
Mailing Address - Phone:925-295-4000
Mailing Address - Fax:
Practice Address - Street 1:1425 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-5318
Practice Address - Country:US
Practice Address - Phone:925-295-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA140000290282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA339040908OtherUSDOL
CA50072OtherBLUE CROSS OF CA
CAHSP40635HMedicaid
CAZZZA0706ZOtherBLUE SHIELD OF CA
CAZZZC0705ZOtherBLUE SHIELD OF CA
CA50635OtherBLUE CROSS OF CA
CAZZR00072FMedicaid
CA050072B000000OtherSECTION 1011-DHS
CAZZZA0706ZOtherBLUE SHIELD OF CA
CAZZZC0705ZOtherBLUE SHIELD OF CA
CA050072B000000OtherSECTION 1011-DHS
CA=========94596-0000OtherTRICARE
CAZZZA0706ZOtherBLUE SHIELD OF CA
CA=========94553-0000OtherTRICARE