Provider Demographics
NPI:1760602726
Name:JOHN MUIR HEALTH
Entity Type:Organization
Organization Name:JOHN MUIR HEALTH
Other - Org Name:MT. DIABLO HOSPITAL EKG DEPT
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-212-0216
Mailing Address - Street 1:5003 COMMERCIAL CIR
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-1268
Mailing Address - Country:US
Mailing Address - Phone:925-939-3000
Mailing Address - Fax:925-941-2236
Practice Address - Street 1:2540 EAST ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-1906
Practice Address - Country:US
Practice Address - Phone:925-939-3000
Practice Address - Fax:925-941-2236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA050496OtherBLUE CROSS
CAZZZC0702ZOtherBLUE SHIELD
CAZZZ07246ZMedicare PIN