Basic Information
Provider Information
NPI: 1962551861
EntityType: 2
ReplacementNPI:  
OrganizationName: JOHN MUIR TRAUMA PHYSICIANS BILLING SERVICE
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Mailing Information
Address1: 1400 TREAT BLVD
Address2: 3RD FLOOR
City: WALNUT CREEK
State: CA
PostalCode: 945972142
CountryCode: US
TelephoneNumber: 9259475331
FaxNumber: 9259412177
Practice Location
Address1: 1601 YGNACIO VALLEY RD
Address2:  
City: WALNUT CREEK
State: CA
PostalCode: 945983122
CountryCode: US
TelephoneNumber: 9259475331
FaxNumber: 9259412177
Other Information
ProviderEnumerationDate: 01/09/2007
LastUpdateDate: 10/17/2012
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AuthorizedOfficialLastName: MOODY
AuthorizedOfficialFirstName: MICHAEL
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AuthorizedOfficialTitleorPosition: CHIEF FINACIAL OFFICER
AuthorizedOfficialTelephone: 9259252159
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MR.
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Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
204E00000X  N193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery 
207L00000X  N193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansAnesthesiology 
207P00000X  N193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansEmergency Medicine 
207Q00000X  N193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansFamily Medicine 
207RC0000X  N193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
207RI0200X  N193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
207W00000X  N193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansOphthalmology 
207XX0801X  N193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
207Y00000X  N193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansOtolaryngology 
2081P0004X  N193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSpinal Cord Injury Medicine
2084P0800X  N193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
2085R0202X  N193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
2086S0122X  N193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
208800000X  N193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansUrology 
2086S0127X  Y193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery

ID Information
IDTypeStateIssuerDescription
GR002814J05CA MEDICAID
GR002814505CA MEDICAID
GR002814805CA MEDICAID
GR002814905CA MEDICAID
GR002814K05CA MEDICAID
GR002814G05CA MEDICAID
GR002814205CA MEDICAID
GR002814405CA MEDICAID
GR002814305CA MEDICAID
GR002814H05CA MEDICAID
GR002814A05CA MEDICAID


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