Provider Demographics
NPI:1356561658
Name:PHYSICIAN ACCESS
Entity type:Organization
Organization Name:PHYSICIAN ACCESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SMITH
Authorized Official - Middle Name:A
Authorized Official - Last Name:KETCHUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-713-5862
Mailing Address - Street 1:49 DRUMM ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94111-4805
Mailing Address - Country:US
Mailing Address - Phone:415-713-5862
Mailing Address - Fax:415-982-2810
Practice Address - Street 1:49 DRUMM ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94111-4805
Practice Address - Country:US
Practice Address - Phone:415-713-5862
Practice Address - Fax:415-982-2810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-27
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine