MEDICARE: BAY AREA COMMUNITY HEALTH

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QF0400X	Federally Qualified Health Center (FQHC)

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

General Provider Information

NPI Number	:	1598387672
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAY AREA COMMUNITY HEALTH

Provider Business Mailing Address
First Line	:	40910 FREMONT BLVD
Second Line	:
City	:	FREMONT
State	:	CA
Zip	:	94538-4375
Country	:	US
Telephone Number	:	510-770-8040
Fax Number	:

Provider Business Practice Location Address
First Line	:	3200 SENTER RD RM S104
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95111-1332
Country	:	US
Telephone Number	:	408-347-4240
Fax Number	:

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	JAGAT SHETH
Credential	:
Telephone Number	:	510-252-6810

Provider Enumeration Date	:	05/12/2020
Last Update Date	:	05/07/2021

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Directions to “BAY AREA COMMUNITY HEALTH ” Practice Location

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