Organization
CHASE DENNIS EMERGENCY MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KRISTOPHER M SMITH (CFO)
(925) 924-1600
Entity
Organization
Contact information
Practice address
1165 MONTGOMERY DR, SANTA ROSA, CA 95405-4801
(925) 924-1600
Mailing address
PO BOX 634718, CINCINNATI, OH 45263-4718
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
207Q00000X
Family Medicine Physician
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
363LP2300X
Primary Care Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CN2451
MEDICARE RR
CA
01
—
DC2287
MEDICARE RR
CA
01
—
DC7119
MEDICARE RR
AZ
01
—
DD4942
MEDICARE RR
CA
Enumeration date
06/14/2006
Last updated
10/09/2015
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