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Organization

SAN LUIS HOSPITALISTS A MEDICAL CORPORATION

Active
Organization subpart
No

Provider details

NPI number
Authorized official
PATRICIA KELLER (ADMINISTRATOR)
(805) 503-8422
Entity
Organization

Contact information

Practice address
1911 JOHNSON AVE, SAN LUIS OBISPO, CA 93401-4197
(805) 543-5353
(805) 542-6661
Mailing address
PO BOX 1464, SAN LUIS OBISPO, CA 93406-1464

Taxonomy

Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
Primary
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1218
CMSP PROVIDER NUMBER
CA
01
ZZZ56478Y
BLUE SHIELD GROUP NUMBER 2 (1911 JOHNSON)
CA
Enumeration date
11/17/2008
Last updated
11/09/2022
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