| East Bay Area Quality Health Corporation | |
|
400 29th Ave Suite 501 Oakland CA 94601-2106 | |
| (510) 268-1800 | |
| (510) 268-1803 |
| Full Name | East Bay Area Quality Health Corporation |
|---|---|
| Speciality | Family Medicine |
| Location | 400 29th Ave, Oakland, California |
| Authorized Official Name and Position | Anthony E. Jones (PRESIDENT) |
| Authorized Official Contact | 5102681800 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| East Bay Area Quality Health Corporation 400 29th Ave Suite 501 Oakland CA 94601-2106 Ph: (510) 268-1800 | East Bay Area Quality Health Corporation 400 29th Ave Suite 501 Oakland CA 94601-2106 Ph: (510) 268-1800 |
| NPI Number | 1295182335 |
|---|---|
| Provider Enumeration Date | 05/18/2016 |
| Last Update Date | 09/22/2016 |
| Medicare PECOS PAC ID | 8527355643 |
|---|---|
| Medicare Enrollment ID | O20160916001915 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295182335 | NPI | - | NPPES |
| CA209814 | Other | CA | MEDICARE PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | A64757 (California) | Primary |
| 207RI0200X | Internal Medicine - Infectious Disease | G73584 (California) | Secondary |
| Provider Name | Lisha L Wilson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1003809765 PECOS PAC ID: 2961550454 Enrollment ID: I20090512000156 |
| Provider Name | Anthony E Jones |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1538246194 PECOS PAC ID: 3476606104 Enrollment ID: I20090728000898 |
| Provider Name | Jaime Young |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780157651 PECOS PAC ID: 2769870120 Enrollment ID: I20211104000445 |
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