Provider Demographics
NPI: | 1457761504 |
---|---|
Name: | JOHN MUIR PHYSICIAN NETWORK |
Entity Type: | Organization |
Organization Name: | JOHN MUIR PHYSICIAN NETWORK |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | SENIOR VICE PRESIDENT |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | KIRK |
Authorized Official - Middle Name: | L |
Authorized Official - Last Name: | MILLER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 925-952-2888 |
Mailing Address - Street 1: | DEPT 34929 |
Mailing Address - Street 2: | P. O. BOX 39000 |
Mailing Address - City: | SAN FRANCISCO |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 94139-0001 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 925-952-2828 |
Mailing Address - Fax: | 925-952-2850 |
Practice Address - Street 1: | 2700 GRANT ST |
Practice Address - Street 2: | SUITE 106 |
Practice Address - City: | CONCORD |
Practice Address - State: | CA |
Practice Address - Zip Code: | 94520-2266 |
Practice Address - Country: | US |
Practice Address - Phone: | 925-685-7598 |
Practice Address - Fax: | 925-685-0752 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2014-04-29 |
Last Update Date: | 2014-07-10 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Single Specialty |