Healthcare Provider Details

I. General information

NPI: 1932593399
Provider Name (Legal Business Name): PSINC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2015
Last Update Date: 05/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 CASTRO ST STE 111
SAN FRANCISCO CA
94114-1019
US

IV. Provider business mailing address

45 CASTRO ST STE 111
SAN FRANCISCO CA
94114-1019
US

V. Phone/Fax

Practice location:
  • Phone: 415-565-6136
  • Fax: 415-864-1654
Mailing address:
  • Phone: 415-565-6136
  • Fax: 415-864-1654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberG49617
License Number StateCA

VIII. Authorized Official

Name: GREGORY M BUNCKE
Title or Position: CLINIC DIRECTOR/
Credential: M.D.
Phone: 415-565-6136