# BOUCH MEDICAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Hill Park Medical Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1720467962
- **Authorized official:** SUMMER BEGIN (PRACTICE MANAGER)
- **Authorized official phone:** (707) 861-7300

## Contact information

- **Practice address:** 435 PETALUMA AVE STE 150, SEBASTOPOL, CA 95472-4273
- **Practice address phone:** (707) 861-7300
- **Practice address fax:** (707) 823-8568
- **Mailing address:** 435 PETALUMA AVE STE 150, SEBASTOPOL, CA 95472-4273
- **Mailing address phone:** (707) 861-7300
- **Mailing address fax:** (707) 823-8568

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 163WG0000X | General Practice Registered Nurse | 393692 | CA | — |
| 204D00000X | Neuromusculoskeletal Medicine & OMM Physician | 20A9470 | CA | — |
| 207R00000X | Internal Medicine Physician | G55518 | CA | — |
| 208D00000X | General Practice Physician | G35969 | CA | Yes |
| 208D00000X | General Practice Physician | ND-353 | CA | — |
| 208D00000X | General Practice Physician | ND-613 | CA | — |

## Other

- **Enumeration date:** 05/20/2015
- **Last updated:** 05/20/2015