Healthcare Provider Details

I. General information

NPI: 1336126499
Provider Name (Legal Business Name): ST MORITZ MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 08/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 PROVIDENCE MINE RD STE 105
NEVADA CITY CA
95959-2945
US

IV. Provider business mailing address

202 PROVIDENCE MINE RD STE 105
NEVADA CITY CA
95959-2945
US

V. Phone/Fax

Practice location:
  • Phone: 530-264-7475
  • Fax: 916-318-6950
Mailing address:
  • Phone: 530-264-7475
  • Fax: 916-318-6950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A4866
License Number StateCA

VIII. Authorized Official

Name: LINDA KAY FOSHAGEN
Title or Position: PRESIDENT
Credential: DO
Phone: 530-264-7475