Basic Information
| Provider Information | |||||||||
| NPI: | 1013253681 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE PERMANENTE MEDICAL GROUP, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1800 HARRISON ST | ||||||||
| Address2: | 7TH FLOOR | ||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946123466 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5106256262 | ||||||||
| FaxNumber: | 5106256226 | ||||||||
| Practice Location | |||||||||
| Address1: | 6600 BRUCEVILLE RD | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958234671 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9166882574 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2012 | ||||||||
| LastUpdateDate: | 12/29/2012 | ||||||||
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| AuthorizedOfficialLastName: | HINTON | ||||||||
| AuthorizedOfficialFirstName: | ROBIN | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | TPMG HR COMPLIANCE/ADMINISTRATION | ||||||||
| AuthorizedOfficialTelephone: | 5106256262 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 705585 | CA | Y | Hospitals | General Acute Care Hospital |
No ID Information.