Healthcare Provider Details

I. General information

NPI: 1093810814
Provider Name (Legal Business Name): EUREKA INTERNAL MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 05/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2280 HARRISON AVE SUITE B
EUREKA CA
95501-3200
US

IV. Provider business mailing address

2280 HARRISON AVE SUITE B
EUREKA CA
95501-3200
US

V. Phone/Fax

Practice location:
  • Phone: 707-449-9371
  • Fax: 707-443-2620
Mailing address:
  • Phone: 707-449-9371
  • Fax: 707-443-2620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHANA COWGILL
Title or Position: IT ADMINISTRATOR
Credential:
Phone: 707-443-6539