Provider Demographics
NPI:1831291350
Name:EAST BAY PEDIATRICS INC
Entity Type:Organization
Organization Name:EAST BAY PEDIATRICS INC
Other - Org Name:EAST BAY PEDIATRIC PRIMARY CARE INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELMER
Authorized Official - Middle Name:
Authorized Official - Last Name:JUMIG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-462-7700
Mailing Address - Street 1:2324 SANTA RITA RD
Mailing Address - Street 2:SUITE 12
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-4152
Mailing Address - Country:US
Mailing Address - Phone:925-462-7700
Mailing Address - Fax:925-462-7712
Practice Address - Street 1:2324 SANTA RITA RD
Practice Address - Street 2:SUITE 12
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-4152
Practice Address - Country:US
Practice Address - Phone:925-462-7700
Practice Address - Fax:925-462-7700
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAST BAY PEDIATRICS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-04
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA77244208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95999OtherPACIFICARE ID #
CA00A772440Medicaid
CA06311574OtherCIGNA PROVIDER #
CA7473685OtherAETNA PROVIDER #
CA2667817OtherUNITED PROVIDER #
CA3672937Medicare UPIN