MEDICARE: BAY AREA CONSORTIUM FOR QUALITY HEALTH CARE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center	140000170	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AYD000300	OTHER	CA	MEDI-CAL PROVIDER NUMBER

General Provider Information

NPI Number	:	1992838437
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAY AREA CONSORTIUM FOR QUALITY HEALTH CARE, INC.

Provider Business Mailing Address
First Line	:	405 14TH ST
Second Line	:	SUITE 300
City	:	OAKLAND
State	:	CA
Zip	:	94612-2715
Country	:	US
Telephone Number	:	510-444-4300
Fax Number	:	510-444-4459

Provider Business Practice Location Address
First Line	:	10850 MACARTHUR BLVD
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94605-5266
Country	:	US
Telephone Number	:	510-843-6194
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	DR. GWEN ROWE-LEE SYKES
Credential	:	DRPH, MSW, MPH
Telephone Number	:	510-444-4300

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	04/27/2015

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