Provider Demographics
NPI:1346061355
Name:SPRINTER MEDICAL EAST, PC
Entity type:Organization
Organization Name:SPRINTER MEDICAL EAST, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-778-1011
Mailing Address - Street 1:4600 BOHANNON DR STE 1000
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-1034
Mailing Address - Country:US
Mailing Address - Phone:209-677-7468
Mailing Address - Fax:
Practice Address - Street 1:4600 BOHANNON DR STE 1000
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-1034
Practice Address - Country:US
Practice Address - Phone:209-677-7468
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-22
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty