Healthcare Provider Details

I. General information

NPI: 1437168861
Provider Name (Legal Business Name): NORTH BAY RADIOLOGY MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 09/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 JANES RD
ARCATA CA
95521-4742
US

IV. Provider business mailing address

PO BOX 3222
NAPA CA
94558-0293
US

V. Phone/Fax

Practice location:
  • Phone: 707-825-4972
  • Fax: 707-825-4919
Mailing address:
  • Phone: 707-261-7823
  • Fax: 707-256-3508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA23851
License Number StateCA

VIII. Authorized Official

Name: DR. WESLEY EATON ROOT
Title or Position: PRESIDENT
Credential:
Phone: 707-261-7880