Organization
ANDERSON VALLEY HEALTH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN D SMITH M.D. (CEO)
(707) 895-3477
Entity
Organization
Contact information
Practice address
13500 AIRPORT ROAD, BOONVILLE, CA 95415
(707) 895-3477
(707) 895-2035
Mailing address
PO BOX 338, BOONVILLE, CA 95415-0338
(707) 895-3477
(707) 895-2035
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
110000165
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
051024
—
CA
05
—
FHC03881F
—
CA
Enumeration date
12/22/2005
Last updated
07/25/2015
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