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Organization
PEACH TREE CLINIC INC
Active
Organization
PEACH TREE CLINIC INC
Active
Parent organization
PEACH TREE CLINIC INC
Other names
Live Oak Medical Clinic
Organization subpart
Yes
Provider details
NPI number
Legal business name
PEACH TREE CLINIC INC
Authorized official
JOSEPH M COULTER M.D. (EXECUTIVE DIRECTOR)
(530) 741-6245
Entity
Organization
Contact information
Practice address
5730 PACKARD AVE, STE 600, MARYSVILLE, CA 95901-7118
(530) 741-6245
(530) 743-5044
Mailing address
5730 PACKARD AVE, STE 600, MARYSVILLE, CA 95901-7118
(530) 741-6245
(530) 743-5044
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1316096894
—
CA
Enumeration date
05/28/2008
Last updated
05/28/2008
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