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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