Provider Demographics
NPI:1083777163
Name:PERMANENTE MEDICAL GROUP, INC.
Entity type:Organization
Organization Name:PERMANENTE MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:T
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-295-7207
Mailing Address - Street 1:5820 OWENS DR. BUILDING E, 2ND FLOOR
Mailing Address - Street 2:TPMG FINANCIAL MANAGEMENT
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-3900
Mailing Address - Country:US
Mailing Address - Phone:510-987-1000
Mailing Address - Fax:
Practice Address - Street 1:1725 EASTSHORE HWY
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94710-1703
Practice Address - Country:US
Practice Address - Phone:510-559-5116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PERMANENTE MEDICAL GROUP, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-19
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10751 & 3237291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory