Organization
UKIAH VALLEY PRIMARY CARE MEDICAL GROUP, INC
Active
Organization
UKIAH VALLEY PRIMARY CARE MEDICAL GROUP, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEREMY MANN M.D. (PRESIDENT, BOARD OF DIRECTORS)
(707) 463-8000
Entity
Organization
Contact information
Practice address
260 HOSPITAL DR. STE. 207, UKIAH, CA 95482-4533
(707) 463-8000
(707) 462-1111
Mailing address
PO BOX 2739, UKIAH, CA 95482-2739
(707) 463-8000
(707) 462-1111
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GPT000830
—
CA
05
—
GR0067100
—
CA
05
—
RHM03947G
—
CA
Enumeration date
12/06/2005
Last updated
06/03/2009
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