Provider Demographics
NPI:1982726576
Name:BAY SURGEONS MEDICAL GROUP
Entity Type:Organization
Organization Name:BAY SURGEONS MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:F
Authorized Official - Last Name:KREMEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-532-4400
Mailing Address - Street 1:1225 MARSHALL ST
Mailing Address - Street 2:STE 7
Mailing Address - City:CRESCENT CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95531-2281
Mailing Address - Country:US
Mailing Address - Phone:707-464-6372
Mailing Address - Fax:707-464-9593
Practice Address - Street 1:3798 JANES RD
Practice Address - Street 2:STE 6
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-4753
Practice Address - Country:US
Practice Address - Phone:707-822-2279
Practice Address - Fax:707-464-9593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00G569970208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G569970Medicaid
CA00G569970Medicaid
CAYYY49056YMedicare PIN