Basic Information
| Provider Information | |||||||||
| NPI: | 1083171268 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BAY AREA SURGICAL SPECIALISTS INC A MEDICAL CORPORATION | ||||||||
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| OtherOrganizationName: | BASS MEDICAL GROUP | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2637 SHADELANDS DR | ||||||||
| Address2: | |||||||||
| City: | WALNUT CREEK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945982512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9259488143 | ||||||||
| FaxNumber: | 9252154540 | ||||||||
| Practice Location | |||||||||
| Address1: | 1208 E ARQUES AVE STE 113 | ||||||||
| Address2: | |||||||||
| City: | SUNNYVALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940855419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4087308082 | ||||||||
| FaxNumber: | 0873005484 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/25/2019 | ||||||||
| LastUpdateDate: | 03/25/2021 | ||||||||
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| AuthorizedOfficialLastName: | RHODES | ||||||||
| AuthorizedOfficialFirstName: | GREGORY | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT, AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 9259326330 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 03/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QS1200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Sleep Disorder Diagnostic |
No ID Information.