Organization
KONOCTI EMERGENCY PHYSICIANS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES T MITCHELL MD (GENERAL PARTNER)
(805) 563-3011
Entity
Organization
Contact information
Practice address
15630 18TH AVE, CLEARLAKE, CA 95422-9336
(707) 994-6486
Mailing address
3916 STATE ST, #300, SANTA BARBARA, CA 93105-5602
(805) 563-3011
(805) 564-5087
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ55400Y
BLUESHIELD
CA
Enumeration date
11/29/2008
Last updated
02/06/2009
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