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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