Provider Demographics
NPI:1932107331
Name:EAST BAY MEDICAL ONCOLOGY-HEMATOLOGY ASSOCIATES, INC.
Entity Type:Organization
Organization Name:EAST BAY MEDICAL ONCOLOGY-HEMATOLOGY ASSOCIATES, INC.
Other - Org Name:EPIC CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:T
Authorized Official - Last Name:GANEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-687-2570
Mailing Address - Street 1:4721 DALLAS RANCH ROAD
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94531-8811
Mailing Address - Country:US
Mailing Address - Phone:925-778-0679
Mailing Address - Fax:925-778-3567
Practice Address - Street 1:4721 DALLAS RANCH RD
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94531-8811
Practice Address - Country:US
Practice Address - Phone:925-778-0679
Practice Address - Fax:925-778-3567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-08
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA36088207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ39156ZMedicare PIN
CA6217260001Medicare NSC