Provider Demographics
NPI:1255385415
Name:EAST BAY REGIONAL CRITICAL CARE AND PULMONARY MEDICINE, INC.
Entity type:Organization
Organization Name:EAST BAY REGIONAL CRITICAL CARE AND PULMONARY MEDICINE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:MCFEELY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-465-6800
Mailing Address - Street 1:411 30TH ST
Mailing Address - Street 2:SUITE 314
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3312
Mailing Address - Country:US
Mailing Address - Phone:510-841-0689
Mailing Address - Fax:510-841-8119
Practice Address - Street 1:411 30TH ST
Practice Address - Street 2:SUITE 314
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3312
Practice Address - Country:US
Practice Address - Phone:510-465-6800
Practice Address - Fax:510-268-0634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAFNP 32519207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ28799ZMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
ZZZ28799ZMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER