Basic Information
| Provider Information | |||||||||
| NPI: | 1841712155 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BAY AREA SURGICAL SPECIALISTS, INC. A MEDICAL CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 365 LENNON LN STE 250 | ||||||||
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| City: | WALNUT CREEK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945985915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9259488143 | ||||||||
| FaxNumber: | 9252154540 | ||||||||
| Practice Location | |||||||||
| Address1: | 2150 APPIAN WAY STE 201 | ||||||||
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| City: | PINOLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945642520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5107245922 | ||||||||
| FaxNumber: | 5103237533 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2017 | ||||||||
| LastUpdateDate: | 07/12/2017 | ||||||||
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| AuthorizedOfficialLastName: | RHODES | ||||||||
| AuthorizedOfficialFirstName: | GREGORY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT, AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 9259488143 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RS0012X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine |
No ID Information.