Provider Demographics
NPI:1245365782
Name:ACCESS MULTI-SPECIALTY MEDICAL CLINIC, INC
Entity type:Organization
Organization Name:ACCESS MULTI-SPECIALTY MEDICAL CLINIC, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:U
Authorized Official - Last Name:LEVINSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-596-1151
Mailing Address - Street 1:PO BOX 351
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94011-0351
Mailing Address - Country:US
Mailing Address - Phone:415-857-1151
Mailing Address - Fax:650-727-0551
Practice Address - Street 1:25 EDWARDS CT
Practice Address - Street 2:SUITE 101
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-2429
Practice Address - Country:US
Practice Address - Phone:415-587-1151
Practice Address - Fax:650-727-0551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA63654101YA0400X, 2084A0401X, 2084P0800X, 2084P0802X, 2084P2900X, 208D00000X, 208VP0000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Multi-Specialty
No2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHA188AMedicare Oscar/Certification
CAHA188AMedicare PIN