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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