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General NPI Number Information
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NPI Number | 1326919655
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Entity Type | Organization
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Legal Business Name | HEADQUARTERS MEDICAL GROUP PA
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Dates
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Enumeration Date | 09/17/2025
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Last Update Date | 09/17/2025
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Provider Practice Location Address
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Address Line | 2340 VAN NESS AVE APT 5
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City | SAN FRANCISCO
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State | CA
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Zip | 94109-1848
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Country | US
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Telephone | 415-763-5790
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Fax |
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Provider Business Mailing Address
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Address Line | 2340 VAN NESS AVE APT 5
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City | SAN FRANCISCO
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State | CA
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Zip | 94109-1848
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OPERATIONS ADMINISTRATOR
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Name | LUCAS JOHNSTON
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Credential |
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Telephone | 973-270-3396
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2080S0010X
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Taxonomy Name | Pediatric Sports Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2081P0301X
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Taxonomy Name | Brain Injury Medicine (Physical Medicine & Rehabilitation) Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 2084P0301X
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Taxonomy Name | Brain Injury Medicine (Psychiatry & Neurology) Physician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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