MEDICARE: MILLS-PENINSULA HEALTH SERVICES

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	291U00000X	Clinical Medical Laboratory
2	291U00000X	Clinical Medical Laboratory	CA
3	282N00000X	General Acute Care Hospital	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518937051
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILLS-PENINSULA HEALTH SERVICES

Provider Business Mailing Address
First Line	:	PO BOX 742738
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90074-2738
Country	:	US
Telephone Number	:	650-696-5400
Fax Number	:	650-652-3052

Provider Business Practice Location Address
First Line	:	1501 TROUSDALE DR
Second Line	:
City	:	BURLINGAME
State	:	CA
Zip	:	94010-4506
Country	:	US
Telephone Number	:	650-696-5400
Fax Number	:	650-652-3052

Authorized Official
Title or Position	:	CFO SHBA
Name	:	JOHN GATES
Credential	:
Telephone Number	:	510-450-7357

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	04/21/2016

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