# NORTHERN CALIFORNIA MEDICAL ASSOC INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1629193438
- **Authorized official:** MS. RUTH ANN SKIDMORE (CHIEF EXECUTIVE OFFICER)
- **Authorized official phone:** (707) 573-6925

## Contact information

- **Practice address:** 1310 PRENTICE DR, STE G, HEALDSBURG, CA 95448-5005
- **Practice address phone:** (707) 433-0216
- **Practice address fax:** (707) 433-6674
- **Mailing address:** 3536 MENDOCINO AVE, STE 200, SANTA ROSA, CA 95403-3634
- **Mailing address phone:** (707) 525-6485
- **Mailing address fax:** (707) 573-6918

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |
| 207XX0005X | Sports Medicine (Orthopaedic Surgery) Physician | — | NULL | — |
| 207XX0005X | Sports Medicine (Orthopaedic Surgery) Physician | — | — | — |

## Other

- **Enumeration date:** 03/20/2007
- **Last updated:** 12/12/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | GR000173H | — | CA |
| 01 | — | ZZZ36779Z | BLUE SHIELD OF CALIFORNIA | CA |