Healthcare Provider Details

I. General information

NPI: 1649223900
Provider Name (Legal Business Name): RCOA-ADVENTIST HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 08/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18TH AVENUE AT HIGHWAY 53
CLEARLAKE CA
95422
US

IV. Provider business mailing address

P. O . BOX 850001
ORLANDO FL
32885-0120
US

V. Phone/Fax

Practice location:
  • Phone: 866-293-3500
  • Fax: 866-293-3535
Mailing address:
  • Phone: 866-293-3500
  • Fax: 866-293-3535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number6838-17
License Number StateCA

VIII. Authorized Official

Name: MR. ALLEN MCGEE
Title or Position: CHAIRMAN & CEO
Credential:
Phone: 561-477-3500