Provider Demographics
NPI:1972776730
Name:EAST BAY MEDICAL ONCOLOGY-HEMATOLOGY ASSOCIATES
Entity Type:Organization
Organization Name:EAST BAY MEDICAL ONCOLOGY-HEMATOLOGY ASSOCIATES
Other - Org Name:EPIC CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PHELPS
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-771-1404
Mailing Address - Street 1:4721 DALLAS RANCH RD
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:2008-04-11
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG39816207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Single Specialty