NPIMap

Organization Active NPI

East Bay Surgical Associates, a Medical Corporation

  • Surgery Physician
  • Antioch, CA
National Provider Identifier
1689858748
Registry record updated May 15, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
EAST BAY SURGICAL ASSOCIATES, A MEDICAL CORPORATION
Practice address
3903 Lone Tree Way
Suite 210
Antioch, CA 94509-6249
Phone
(925) 757-0800
Fax
(925) 757-2160
NPI assigned
Dec 26, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 15, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Phillip W.T. Polido, M.D.
Title
Owner/President
Phone
(925) 757-0800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208600000X Primary

Addresses

Primary practice location

3903 Lone Tree Way
Suite 210
Antioch, CA 94509-6249

Mailing address

3903 Lone Tree Way
Suite 210
Antioch, CA 94509-6249
Phone (925) 757-0800

National Provider Directory

National Provider Directory

Locations

3903 Lone Tree Way
Ste 210
Antioch, CA 94509
Phone (925) 754-0700

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1198627200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210809600000",
    "number": "1689858748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3903 LONE TREE WAY",
            "address_2": "SUITE 210",
            "city": "ANTIOCH",
            "state": "CA",
            "postal_code": "945096249",
            "telephone_number": "925-757-0800",
            "fax_number": "925-757-2160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3903 LONE TREE WAY",
            "address_2": "SUITE 210",
            "city": "ANTIOCH",
            "state": "CA",
            "postal_code": "945096249",
            "telephone_number": "925-757-0800",
            "fax_number": "925-757-2160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST BAY SURGICAL ASSOCIATES, A MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-26",
        "last_updated": "2008-05-15",
        "status": "A",
        "authorized_official_last_name": "POLIDO",
        "authorized_official_first_name": "PHILLIP",
        "authorized_official_middle_name": "W.T.",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "925-757-0800",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Antioch, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.