Provider Demographics
NPI:1811021405
Name:EAST BAY PERINATAL CENTER
Entity Type:Organization
Organization Name:EAST BAY PERINATAL CENTER
Other - Org Name:ALTA BATES SUMMIT PERINATAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROSWITHA
Authorized Official - Middle Name:
Authorized Official - Last Name:CALHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-869-8680
Mailing Address - Street 1:350 30TH ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3425
Mailing Address - Country:US
Mailing Address - Phone:510-869-8425
Mailing Address - Fax:510-506-7710
Practice Address - Street 1:350 30TH ST
Practice Address - Street 2:STE 205
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3425
Practice Address - Country:US
Practice Address - Phone:510-869-8425
Practice Address - Fax:510-506-7710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550000581261Q00000X, 261QC1500X, 261QF0050X, 261QP2300X
CA05D0942632 CLP322959291U00000X
CADEA #FE05751223336C0002X
CABD OF PHARMACY #18223336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No291U00000XLaboratoriesClinical Medical Laboratory
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD585OtherMEDI-CAL PRESUMPTIVE ELIG
CACMM71192FMedicaid