Provider Demographics
NPI:1699979831
Name:WEST COUNTY ORTHOPAEDIC CLINIC
Entity type:Organization
Organization Name:WEST COUNTY ORTHOPAEDIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:VICKY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-223-1430
Mailing Address - Street 1:1660 SAN PABLO AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:PINOLE
Mailing Address - State:CA
Mailing Address - Zip Code:94564-2077
Mailing Address - Country:US
Mailing Address - Phone:510-223-1430
Mailing Address - Fax:510-223-1470
Practice Address - Street 1:1660 SAN PABLO AVE
Practice Address - Street 2:SUITE A
Practice Address - City:PINOLE
Practice Address - State:CA
Practice Address - Zip Code:94564-2072
Practice Address - Country:US
Practice Address - Phone:510-223-1430
Practice Address - Fax:510-223-1470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ27590ZMedicare ID - Type UnspecifiedINCORPORATED MEDICAL PRAC