MEDICARE: COUNTY OF MENDOCINO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2400X	Prison Health Clinic/Center

General Provider Information

NPI Number	:	1639060213
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTY OF MENDOCINO

Provider Business Mailing Address
First Line	:	951 LOW GAP RD
Second Line	:
City	:	UKIAH
State	:	CA
Zip	:	95482-3736
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	951 LOW GAP RD
Second Line	:
City	:	UKIAH
State	:	CA
Zip	:	95482-3736
Country	:	US
Telephone Number	:	707-463-4083
Fax Number	:

Authorized Official
Title or Position	:	SHERIFF'S CAPTAIN / JAIL COMMANDER
Name	:	MR. GREGORY LEE VAN PATTEN
Credential	:
Telephone Number	:	707-463-4083

Provider Enumeration Date	:	07/11/2025
Last Update Date	:	07/11/2025

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Directions to “COUNTY OF MENDOCINO ” Practice Location

Language	Start Address	Practice Location

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