Provider Demographics
NPI:1760637896
Name:SAN LUIS HOSPITALISTS A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:SAN LUIS HOSPITALISTS A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-503-8422
Mailing Address - Street 1:PO BOX 1464
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93406-1464
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1911 JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-4197
Practice Address - Country:US
Practice Address - Phone:805-543-5353
Practice Address - Fax:805-542-6661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-17
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ56478YOtherBLUE SHIELD GROUP NUMBER 2 (1911 JOHNSON)
CA1218OtherCMSP PROVIDER NUMBER
CAZZZ56477YOtherBLUE SHIELD GROUP NUMBER (1010 MURRAY)
CABM261AMedicare PIN
CABM183ZMedicare PIN