Organization
PEACH TREE HEALTHCARE
Active
Organization
PEACH TREE HEALTHCARE
Active
Other names
Live Oak Medical Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GREG STONE (CEO)
(530) 741-6245
Entity
Organization
Contact information
Practice address
9980 LIVE OAK BLVD, LIVE OAK, CA 95953-2334
(530) 749-3242
(530) 749-3248
Mailing address
1114 YUBA ST STE 220, MARYSVILLE, CA 95901-4838
(530) 749-3242
(530) 749-3248
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
14503TLG
CA
171M00000X
Case Manager/Care Coordinator
—
—
207Q00000X
Family Medicine Physician
C51576
CA
207V00000X
Obstetrics & Gynecology Physician
A93985
CA
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
550000248
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
FHC71147F
—
CA
Enumeration date
01/10/2007
Last updated
05/23/2022
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