Provider Demographics
NPI:1013906221
Name:SUTTER EAST BAY HOSPITALS
Entity Type:Organization
Organization Name:SUTTER EAST BAY HOSPITALS
Other - Org Name:ALTA BATES SUMMIT MEDICAL CENTER - ASHBY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP SHBA
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:GATES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-297-8453
Mailing Address - Street 1:PO BOX 742920
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-2920
Mailing Address - Country:US
Mailing Address - Phone:855-398-1633
Mailing Address - Fax:
Practice Address - Street 1:2450 ASHBY AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2067
Practice Address - Country:US
Practice Address - Phone:510-204-1682
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-19
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14000004282N00000X
CA140000004291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHSC00305FMedicaid
CAZZR00305FMedicaid
CAHSP40305FMedicaid
CAZZR00305FMedicaid