Organization
MAD RIVER COMMUNITY ANESTHESIA MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL J YOUNG (C.F.O.)
(707) 826-8203
Entity
Organization
Contact information
Practice address
3800 JANES RD, ARCATA, CA 95521-4742
(707) 822-7250
(707) 826-8258
Mailing address
PO BOX 1115, ARCATA, CA 95518-1115
(707) 822-7250
(707) 826-8258
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
CA
Enumeration date
06/23/2006
Last updated
08/22/2020
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