Organization
PENINSULA SURGICAL SPECIALIST MEDICAL GROUP, INC.
Active
Parent organization
SURGICAL ASSOCIATES OF THE PENINSULA
Other names
Surgical Associates of the Peninsula A Medical Group, Inc.
Organization subpart
Yes
Provider details
NPI number
Legal business name
SURGICAL ASSOCIATES OF THE PENINSULA
Authorized official
DR. DIRK BAUMANN M.D. (CFO)
(650) 777-4064
Entity
Organization
Contact information
Practice address
1720 EL CAMINO REAL, SUITE 101, BURLINGAME, CA 94010-3224
(650) 652-0600
Mailing address
1720 EL CAMINO REAL, SUITE 101, BURLINGAME, CA 94010-3224
(650) 652-0600
Taxonomy
Speciality
Code
Description
License number
State
246ZS0410X
Surgical Technologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CG1015
RAILROAD MEDICARE
CA
01
—
P00405374
RAILROAD MEDICARE
CA
01
—
P00411831
RAILROAD MEDICARE
CA
01
—
P00431764
RAILROAD MEDICARE
CA
Enumeration date
10/10/2006
Last updated
03/10/2008
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