Provider Demographics
NPI:1932278702
Name:UCSF MEDICAL GROUP BUSINESS SERVICES
Entity Type:Organization
Organization Name:UCSF MEDICAL GROUP BUSINESS SERVICES
Other - Org Name:UCSF OTOLARYNGOLOGY MED GRP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:JED
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIVERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-476-4003
Mailing Address - Street 1:1635 DIVISADERO ST
Mailing Address - Street 2:SUITE 625, BOX 1821
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-0001
Mailing Address - Country:US
Mailing Address - Phone:415-353-2757
Mailing Address - Fax:415-353-2603
Practice Address - Street 1:350 PARNASSUS AVE
Practice Address - Street 2:210
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-0001
Practice Address - Country:US
Practice Address - Phone:415-353-2757
Practice Address - Fax:415-353-2603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207Y00000X, 207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
Not Answered207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0084293Medicaid
CAGR0084293Medicaid