Provider Demographics
NPI:1689634891
Name:SAN MATEO ENDOSCOPY CENTER
Entity Type:Organization
Organization Name:SAN MATEO ENDOSCOPY CENTER
Other - Org Name:MID PENINSULA ENDOSCOPY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MAINARDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-340-9977
Mailing Address - Street 1:50 S. SAN MATEO DR.
Mailing Address - Street 2:# 400
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-3861
Mailing Address - Country:US
Mailing Address - Phone:650-579-7082
Mailing Address - Fax:650-579-7743
Practice Address - Street 1:50 S SAN MATEO DR
Practice Address - Street 2:# 400
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-3857
Practice Address - Country:US
Practice Address - Phone:650-579-7082
Practice Address - Fax:650-579-7743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASUR01370FMedicaid
CA4422407OtherCIGNA ID
CA051370OtherBLUE CROSS ID
CA051370OtherBLUE CROSS ID