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
DARCIE ANNE ANTLE (ADMINISTRATOR)
(707) 463-8000
Entity
Organization
Contact information
Practice address
240 HOSPITAL DR STE A, UKIAH, CA 95482-4558
(707) 463-8000
(707) 463-8006
Mailing address
PO BOX 2739, UKIAH, CA 95482-2739
(707) 463-8000
(707) 463-8006
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
A43219
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A432190
—
CA
05
—
1609874445
—
CA
Enumeration date
08/17/2009
Last updated
08/17/2009
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