Organization
EAST BAY ENDOSCOPY CENTER L P
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRADLEY HEATON (CEO)
(916) 566-4907
Entity
Organization
Contact information
Practice address
5858 HORTON ST, STE 100, EMERYVILLE, CA 94608-2007
(510) 654-4554
(510) 654-4594
Mailing address
5858 HORTON ST, SUITE 100, EMERYVILLE, CA 94608-2006
(510) 654-4554
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
140000597
STATE LICENSE
CA
01
—
20889
AAAHC ORGANIZATION ID
—
05
—
AURO1463F
—
CA
01
—
ZZZH0112Z
BLUE SHIELD OF CA
CA
Enumeration date
06/21/2005
Last updated
04/26/2024
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