Provider Demographics
NPI:1811242563
Name:SUTTER WEST BAY MEDICAL FOUNDATION
Entity type:Organization
Organization Name:SUTTER WEST BAY MEDICAL FOUNDATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:COHILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-600-7771
Mailing Address - Street 1:2015 STEINER ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-2627
Mailing Address - Country:US
Mailing Address - Phone:415-600-4280
Mailing Address - Fax:415-600-2128
Practice Address - Street 1:1200 SONOMA AVE
Practice Address - Street 2:STE 2
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-6664
Practice Address - Country:US
Practice Address - Phone:707-571-2192
Practice Address - Fax:707-571-2194
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUTTER WEST BAY MEDICAL FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-07-18
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical