Provider Demographics
NPI:1710907506
Name:JOHN MUIR PHYSICIAN NETWORK
Entity Type:Organization
Organization Name:JOHN MUIR PHYSICIAN NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT PRACTICE ADM
Authorized Official - Prefix:
Authorized Official - First Name:M
Authorized Official - Middle Name:KATHERINE
Authorized Official - Last Name:SORENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-952-2888
Mailing Address - Street 1:PO BOX 9017
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-0917
Mailing Address - Country:US
Mailing Address - Phone:925-952-2828
Mailing Address - Fax:925-952-2850
Practice Address - Street 1:140 BROOKWOOD RD
Practice Address - Street 2:SUITE 201
Practice Address - City:ORINDA
Practice Address - State:CA
Practice Address - Zip Code:94563-3042
Practice Address - Country:US
Practice Address - Phone:925-254-9090
Practice Address - Fax:925-254-4399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR006875HMedicaid
CACE7104Medicare PIN
CACH0335Medicare PIN
CACD4001Medicare PIN
CACI4093Medicare PIN
CAZZZ47768ZMedicare PIN
CAGR006875HMedicaid
CACD2399Medicare PIN