Healthcare Provider Details

I. General information

NPI: 1326246828
Provider Name (Legal Business Name): NORTH COAST SURGICAL SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2007
Last Update Date: 11/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2321 HARRISON AVE
EUREKA CA
95501-3216
US

IV. Provider business mailing address

PO BOX 7160
EUREKA CA
95502-7160
US

V. Phone/Fax

Practice location:
  • Phone: 707-445-3660
  • Fax:
Mailing address:
  • Phone: 707-445-3674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL A PALMER
Title or Position: PRESIDENT
Credential:
Phone: 707-445-3674