Healthcare Provider Details

I. General information

NPI: 1457400293
Provider Name (Legal Business Name): JOHN MUIR TRAUMA PHYSICIANS BILLING SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 02/23/2023
Certification Date: 02/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 YGNACIO VALLEY RD
WALNUT CREEK CA
94598-3122
US

IV. Provider business mailing address

PO BOX 9021
WALNUT CREEK CA
94598-0921
US

V. Phone/Fax

Practice location:
  • Phone: 925-947-5331
  • Fax: 925-941-2177
Mailing address:
  • Phone: 925-947-5331
  • Fax: 925-941-2177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. MIKE THOMAS
Title or Position: CEO
Credential:
Phone: 925-941-2100