Basic Information
| Provider Information | |||||||||
| NPI: | 1639523004 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUTTER BAY HOSPITALS | ||||||||
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| OtherOrganizationName: | ALTA BATES SUMMIT MEDICAL CENTER - ALTA BATES CAMPUS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2000 POWELL ST | ||||||||
| Address2: | 10TH FLOOR | ||||||||
| City: | EMERYVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946081804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5104507347 | ||||||||
| FaxNumber: | 5104507309 | ||||||||
| Practice Location | |||||||||
| Address1: | 2450 ASHBY AVENUE | ||||||||
| Address2: | |||||||||
| City: | BERKELEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 947052067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5108698837 | ||||||||
| FaxNumber: | 5108696811 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2016 | ||||||||
| LastUpdateDate: | 04/15/2021 | ||||||||
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| AuthorizedOfficialLastName: | GATES | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | B. | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 5104507357 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 04/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | N | Laboratories | Clinical Medical Laboratory | 282N00000X | Y | Hospitals | General Acute Care Hospital |
No ID Information.