Provider Demographics
NPI:1427181221
Name:SAMUEL MERRITT COLLEGE
Entity type:Organization
Organization Name:SAMUEL MERRITT COLLEGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF FINANCE AND ADMINISTRATION
Authorized Official - Prefix:MISS
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:GINGRAS
Authorized Official - Suffix:
Authorized Official - Credentials:CMA
Authorized Official - Phone:510-869-1588
Mailing Address - Street 1:450 30TH ST
Mailing Address - Street 2:SUITE 2701
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3302
Mailing Address - Country:US
Mailing Address - Phone:510-869-1588
Mailing Address - Fax:510-869-1587
Practice Address - Street 1:450 30TH ST
Practice Address - Street 2:SUITE 2701
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3302
Practice Address - Country:US
Practice Address - Phone:510-869-1588
Practice Address - Fax:510-869-1587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE-4490213E00000X
CAE-2309213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ034527Medicare ID - Type Unspecified