Healthcare Provider Details

I. General information

NPI: 1376570473
Provider Name (Legal Business Name): WILLOW CREEK - SIX RIVERS MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 09/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 STATE HWY 96
WILLOW CREEK CA
95573
US

IV. Provider business mailing address

P.O. BOX 4388
ARCATA CA
95518-4388
US

V. Phone/Fax

Practice location:
  • Phone: 530-629-3777
  • Fax: 530-629-2866
Mailing address:
  • Phone: 707-822-7220
  • Fax: 707-826-8258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DOUGLAS ALLEN SHAW
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 707-822-7220