Organization
HUMBOLDT FAMILY MEDICAL CARE
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
1733 CENTRAL AVE, MCKINLEYVILLE, CA 95519-3601
(707) 839-4852
(707) 839-2439
Mailing address
P.O. BOX 4957, ARCATA, CA 95518-4957
(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
—
05-8505
BLUE CROSS PROVIDER #
CA
05
—
RHM53803G
—
CA
01
—
ZZZ67827Z
BLUE SHEIRLD PROVIDER #
CA
Enumeration date
06/27/2006
Last updated
09/20/2019
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