Provider Demographics
NPI:1992870042
Name:SUTTER WEST BAY MEDICAL FOUNDATION
Entity type:Organization
Organization Name:SUTTER WEST BAY MEDICAL FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:MORRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:FLAUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-600-4220
Mailing Address - Street 1:PO BOX 7999
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94120-7999
Mailing Address - Country:US
Mailing Address - Phone:415-600-4280
Mailing Address - Fax:415-600-4255
Practice Address - Street 1:3801 SACRAMENTO ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1625
Practice Address - Country:US
Practice Address - Phone:415-600-4280
Practice Address - Fax:415-600-4255
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUTTER HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-22
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA05D0962082291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPENDINGMedicare ID - Type Unspecified