Provider Demographics
NPI:1154418093
Name:MILLS PENINSULA HEALTH SERVICES
Entity type:Organization
Organization Name:MILLS PENINSULA HEALTH SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MERWIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-696-5400
Mailing Address - Street 1:PO BOX 60000 FILE #73688
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94160-0001
Mailing Address - Country:US
Mailing Address - Phone:650-696-5400
Mailing Address - Fax:650-652-3051
Practice Address - Street 1:1720 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3224
Practice Address - Country:US
Practice Address - Phone:650-696-5400
Practice Address - Fax:650-652-3051
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MILLS PENINSULA HEALTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-10
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA053516261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACDC03516FMedicaid
CACDC03516FMedicaid