Provider Demographics
NPI:1932131489
Name:SAN RAMON REGIONAL MEDICAL CENTER, LLC
Entity Type:Organization
Organization Name:SAN RAMON REGIONAL MEDICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BEENU
Authorized Official - Middle Name:
Authorized Official - Last Name:CHADHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-275-8433
Mailing Address - Street 1:FILE 57436
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-7436
Mailing Address - Country:US
Mailing Address - Phone:209-578-2513
Mailing Address - Fax:925-275-0107
Practice Address - Street 1:6001 NORRIS CANYON RD
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-5400
Practice Address - Country:US
Practice Address - Phone:925-275-9200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA140000345282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
232976870OtherAETNA US HEALTHCARE
CAHSP40689FMedicaid
ZZZA0700ZOtherBS OF CALIFORNIA
000411OtherHUMANA
050689B000000OtherSECTION 1011
CAHSP30689GMedicaid
CAHSP40689GMedicaid
005041-0001OtherPACIFICARE OF CALIFORNIA
CAHSP40689FMedicaid