Provider Demographics
NPI:1265202725
Name:JOHN MUIR HEALTH
Entity type:Organization
Organization Name:JOHN MUIR HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-941-2100
Mailing Address - Street 1:JOHN MUIR HEALTH
Mailing Address - Street 2:177 LA CASA VIA STE 270
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-6101
Mailing Address - Country:US
Mailing Address - Phone:925-947-4410
Mailing Address - Fax:
Practice Address - Street 1:177 LA CASA VIA STE 270
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-6101
Practice Address - Country:US
Practice Address - Phone:925-947-4410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOHN MUIR HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-01-05
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy