Provider Demographics
NPI:1821195025
Name:GREATER EAST BAY ENDOSCOPY CENTER, INC
Entity Type:Organization
Organization Name:GREATER EAST BAY ENDOSCOPY CENTER, INC
Other - Org Name:GREATER BAY ENDOSCOPY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DEMARS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-538-9900
Mailing Address - Street 1:22455 MAPLE CT
Mailing Address - Street 2:SUITE 150
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-4020
Mailing Address - Country:US
Mailing Address - Phone:510-538-9900
Mailing Address - Fax:510-538-9911
Practice Address - Street 1:22455 MAPLE CT
Practice Address - Street 2:SUITE 150
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-4020
Practice Address - Country:US
Practice Address - Phone:510-538-9900
Practice Address - Fax:510-538-9911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
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