Provider Demographics
NPI:1154428688
Name:SETON MEDICAL CENTER
Entity type:Organization
Organization Name:SETON MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:FERRELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-991-6491
Mailing Address - Street 1:PO BOX 742974
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-2974
Mailing Address - Country:US
Mailing Address - Phone:650-992-4000
Mailing Address - Fax:650-551-6691
Practice Address - Street 1:1900 SULLIVAN AVE
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2200
Practice Address - Country:US
Practice Address - Phone:650-992-4000
Practice Address - Fax:650-551-6691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-19
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA220000026282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABJ596YOtherPTAN
CACI719ZOtherPTAN
CAHSP40289GMedicaid
CACI378ZOtherPTAN
CACI694ZOtherPTAN
CACI682ZOtherPTAN
CACI705ZOtherPTAN
CACK386ZOtherPTAN
CACI649ZOtherPTAN
CAHSC00289GMedicaid
CAZZZ26237ZOtherPTAN
CAHSM00289GMedicaid
CACI708ZOtherPTAN
CAZZR00289GMedicaid
CACI719ZOtherPTAN
CACI649ZOtherPTAN