Healthcare Provider Details

I. General information

NPI: 1013906221
Provider Name (Legal Business Name): SUTTER EAST BAY HOSPITALS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 04/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 ASHBY AVE
BERKELEY CA
94705-2067
US

IV. Provider business mailing address

PO BOX 742920
LOS ANGELES CA
90074-2920
US

V. Phone/Fax

Practice location:
  • Phone: 510-204-1682
  • Fax:
Mailing address:
  • Phone: 855-398-1633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number14000004
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number140000004
License Number StateCA

VIII. Authorized Official

Name: JOHN GATES
Title or Position: VP SHBA
Credential:
Phone: 916-297-8453