Provider Demographics
NPI:1215363403
Name:KOLBECK, BAUER AND STANTON MEDICAL CORPORATION
Entity type:Organization
Organization Name:KOLBECK, BAUER AND STANTON MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:KOLBECK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-863-1496
Mailing Address - Street 1:950 RIVERSIDE PKWY
Mailing Address - Street 2:SUITE 90
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95605-1501
Mailing Address - Country:US
Mailing Address - Phone:916-863-1496
Mailing Address - Fax:916-863-1498
Practice Address - Street 1:950 RIVERSIDE PKWY
Practice Address - Street 2:SUITE 90
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95605-1501
Practice Address - Country:US
Practice Address - Phone:916-863-1496
Practice Address - Fax:916-863-1498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-19
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty