Provider Demographics
NPI:1639355266
Name:NORTH COAST HOSPITALIST, PC
Entity Type:Organization
Organization Name:NORTH COAST HOSPITALIST, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:EIFFERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-278-0804
Mailing Address - Street 1:122 CALISTOGA RD
Mailing Address - Street 2:305
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95409-3702
Mailing Address - Country:US
Mailing Address - Phone:650-278-0804
Mailing Address - Fax:650-473-9654
Practice Address - Street 1:122 CALISTOGA RD
Practice Address - Street 2:305
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95409-3702
Practice Address - Country:US
Practice Address - Phone:650-278-0804
Practice Address - Fax:650-473-9654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-14
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79039207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1508878471Medicare NSC