Organization
WILLOW CREEK - SIX RIVERS MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOUGLAS ALLEN SHAW (CHIEF EXECUTIVE OFFICER)
(707) 822-7220
Entity
Organization
Contact information
Practice address
850 STATE HWY 96, WILLOW CREEK, CA 95573
(530) 629-3777
(530) 629-2866
Mailing address
P.O. BOX 4388, ARCATA, CA 95518-4388
(707) 822-7220
(707) 826-8258
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
55-3980
BLUE CROSS PROVIDER #
CA
01
—
HAP10028F
FAMILY PACT PROVIDER #
CA
05
—
RHM10028F
—
CA
01
—
ZZZ33943Z
BLUE SHIELD PROVIDER #
CA
Enumeration date
06/26/2006
Last updated
09/20/2019
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