| Valleycare Gastroenterology Medical Group Inc | |
|
5575 W Las Positas Blvd Suite 320 Pleasanton CA 94588-5801 | |
| (925) 460-8167 | |
| (925) 460-0246 |
| Full Name | Valleycare Gastroenterology Medical Group Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 5575 W Las Positas Blvd, Pleasanton, California |
| Authorized Official Name and Position | Eric M Rowen (PRESIDENT) |
| Authorized Official Contact | 9254608167 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Valleycare Gastroenterology Medical Group Inc 5575 W. Las Positas Blvd Suite 320 Pleasanton CA 94588-5804 Ph: (925) 460-8167 | Valleycare Gastroenterology Medical Group Inc 5575 W Las Positas Blvd Suite 320 Pleasanton CA 94588-5801 Ph: (925) 460-8167 |
| NPI Number | 1639137094 |
|---|---|
| Provider Enumeration Date | 05/03/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 7618967498 |
|---|---|
| Medicare Enrollment ID | O20040513001348 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639137094 | NPI | - | NPPES |
| 00G832720 | Medicaid | CA | |
| 00G459340 | Medicaid | CA | |
| GR0085610 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | G45934 (California) | Primary |
| Provider Name | Phillip Wolfe |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1710075411 PECOS PAC ID: 5193824738 Enrollment ID: I20081215000220 |
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