Healthcare Provider Details

I. General information

NPI: 1629646161
Provider Name (Legal Business Name): COARSEGOLD CREEK MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2021
Last Update Date: 06/11/2021
Certification Date: 06/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35463 HIGHWAY 41
COARSEGOLD CA
93614-8722
US

IV. Provider business mailing address

PO BOX 970
COARSEGOLD CA
93614-0970
US

V. Phone/Fax

Practice location:
  • Phone: 559-683-6292
  • Fax:
Mailing address:
  • Phone: 559-683-6292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. STEPHEN DAHLIN
Title or Position: OWNER
Credential: DC
Phone: 559-683-6292