Provider Demographics
NPI:1750357539
Name:BAYSPRING MEDICAL GROUP A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:BAYSPRING MEDICAL GROUP A PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-674-2627
Mailing Address - Street 1:1199 BUSH STREET
Mailing Address - Street 2:SUITE # 500
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-5976
Mailing Address - Country:US
Mailing Address - Phone:415-267-2600
Mailing Address - Fax:415-674-2601
Practice Address - Street 1:1199 BUSH STREET
Practice Address - Street 2:SUITE # 500
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-5976
Practice Address - Country:US
Practice Address - Phone:415-267-2600
Practice Address - Fax:415-674-2601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA46339207R00000X
CAG57068207VG0400X
CANP 11738363LF0000X
CAA52654207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMR1207136OtherDEA
CAA 53229Medicare UPIN
CAF 18721Medicare UPIN
CAG 04445Medicare UPIN
CAG 04445Medicare UPIN