Basic Information
| Provider Information | |||||||||
| NPI: | 1801821376 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | JOHN MUIR HEALTH | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | JOHN MUIR HEALTH MEDICAL CENTER, CONCORD CAMPUS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1400 TREAT BLVD | ||||||||
| Address2: | |||||||||
| City: | WALNUT CREEK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945972142 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9259393000 | ||||||||
| FaxNumber: | 9259412236 | ||||||||
| Practice Location | |||||||||
| Address1: | 2540 EAST ST | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945201906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9256828200 | ||||||||
| FaxNumber: | 9256742009 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2006 | ||||||||
| LastUpdateDate: | 08/16/2019 | ||||||||
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| AuthorizedOfficialLastName: | KNIGHT | ||||||||
| AuthorizedOfficialFirstName: | CALVIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT AND CHIEF EXECUTIVE OFFIC | ||||||||
| AuthorizedOfficialTelephone: | 9259412100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 140000128 | CA | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | ZZR00496G | 05 | CA | MEDICAID | HSP40496G | 05 | CA | MEDICAID | 05496A | 01 | CA | BX OF CALIFORNIA | OTHER | ZZZC0702Z | 01 | CA | BLUE SHIELD OF CALIFORNIA | OTHER |